Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | E-9382 | AR |
Y | 2080P0204X | Pediatric Emergency Doctor | R6899 | TX |
NPI | 1114283652 |
---|---|
Provider Name | Dr. Samuel Thomas Selby |
First Address | Dallas, TX 75373-3784 |
Second Address | Fort Worth, TX 76104-2733 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2012 |
Last Update Date | 09/04/2021 |