Provider Demographics
NPI:1780693861
Name:SANCHEZ, SAMUEL EFRAIN (DO)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:EFRAIN
Last Name:SANCHEZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1775
Mailing Address - Street 2:
Mailing Address - City:ARIZONA CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85123-1290
Mailing Address - Country:US
Mailing Address - Phone:520-466-5774
Mailing Address - Fax:520-494-0319
Practice Address - Street 1:13060 S SUNDLAND GIN
Practice Address - Street 2:
Practice Address - City:ARIZONA CITY
Practice Address - State:AZ
Practice Address - Zip Code:85123-1290
Practice Address - Country:US
Practice Address - Phone:520-466-5774
Practice Address - Fax:520-494-0319
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-06
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ005911207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ813868Medicaid
AZ159396Medicare PIN
CAG98234Medicare UPIN