Provider Demographics
NPI:1184796252
Name:SAMPLES, ROXANN M (MD)
Entity type:Individual
Prefix:DR
First Name:ROXANN
Middle Name:M
Last Name:SAMPLES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 LONDONDERRY DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-7915
Mailing Address - Country:US
Mailing Address - Phone:254-776-5970
Mailing Address - Fax:
Practice Address - Street 1:301 LONDONDERRY DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7915
Practice Address - Country:US
Practice Address - Phone:254-776-5970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2749207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113420704Medicaid
TX8X5372OtherBLUE CROSS
TX113420703Medicaid
TX113420703Medicaid
TXP00413250Medicare PIN
TX8F5414Medicare PIN
TX87W350Medicare ID - Type Unspecified