Provider Demographics
NPI:1902028947
Name:SCHROERLUCKE, SAMUEL RAY (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:RAY
Last Name:SCHROERLUCKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6077 PRIMACY PKWY STE 140
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5742
Mailing Address - Country:US
Mailing Address - Phone:901-725-8347
Mailing Address - Fax:901-259-7637
Practice Address - Street 1:1244 PRIMACY PKWY
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-0201
Practice Address - Country:US
Practice Address - Phone:901-767-8662
Practice Address - Fax:901-767-8666
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN45727207X00000X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4269099OtherBCBS TN
TN9993516OtherAETNA
TNP00881379OtherRAILROAD MEDICARE
TN1521876Medicaid
TN620819926OtherAETNA
TX620819926OtherCIGNA
TN103I200667Medicare PIN
TN4269099OtherBCBS TN
TN0723280010Medicare NSC
TX620819926OtherCIGNA
TN3371161Medicare PIN