Provider Demographics
NPI:1922026707
Name:DELK, SAM (MD)
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:
Last Name:DELK
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:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38101-0126
Mailing Address - Country:US
Mailing Address - Phone:901-757-2345
Mailing Address - Fax:901-757-9065
Practice Address - Street 1:1325 EASTMORELAND AVE STE 440
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-7554
Practice Address - Country:US
Practice Address - Phone:901-725-0421
Practice Address - Fax:901-278-4675
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37329208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3003101Medicaid
TN0037329OtherBLUE CROSS BLUE SHIELD
AR114202001Medicaid
TN0037329OtherBLUE CROSS BLUE SHIELD