Provider Demographics
NPI:1255383055
Name:BATTAGLIA, SAM G (MD)
Entity type:Individual
Prefix:
First Name:SAM
Middle Name:G
Last Name:BATTAGLIA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1130 E FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1813
Mailing Address - Country:US
Mailing Address - Phone:208-985-1399
Mailing Address - Fax:208-955-6501
Practice Address - Street 1:1623 S WELLS AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-5040
Practice Address - Country:US
Practice Address - Phone:208-489-1450
Practice Address - Fax:208-489-1451
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2018-10-26
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Provider Licenses
StateLicense IDTaxonomies
IDM8918207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine