Provider Demographics
NPI:1659327872
Name:WAHBY, SAMIR R (MD)
Entity type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:R
Last Name:WAHBY
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 1:2700 1ST AVE S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-4300
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2700 1ST AVE S
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-4306
Practice Address - Country:US
Practice Address - Phone:515-955-6767
Practice Address - Fax:515-576-8581
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23372207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA20058OtherWELLMARK
IA4848OtherMIDLANDS
IA0200584Medicaid
IA4848OtherMIDLANDS
IA20058Medicare ID - Type Unspecified