Provider Demographics
NPI:1891805750
Name:SUH, SAM (PA)
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:
Last Name:SUH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 N MACARTHUR BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-2225
Mailing Address - Country:US
Mailing Address - Phone:972-438-4636
Mailing Address - Fax:214-260-0953
Practice Address - Street 1:2120 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-2225
Practice Address - Country:US
Practice Address - Phone:972-438-4636
Practice Address - Fax:214-260-0953
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00426363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86N348OtherBLUE CROSS
TXS38743Medicare UPIN
TX86N348OtherBLUE CROSS