Provider Demographics
NPI:1891948386
Name:JAMPOLIS, SAMUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:JAMPOLIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6318 RICHMOND AVE
Mailing Address - Street 2:#1302
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-3681
Mailing Address - Country:US
Mailing Address - Phone:855-266-0303
Mailing Address - Fax:
Practice Address - Street 1:6310 SOUTHWEST BLVD
Practice Address - Street 2:STE 204
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76109-3998
Practice Address - Country:US
Practice Address - Phone:817-263-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG46082085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology