Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | J4077 | TX |
Y | 208600000X | Surgeon | J4077 | TX |
NPI | 1013910405 |
---|---|
Provider Name | Sammy Anthony Deeb |
First Address | Lubbock, TX 79410-1307 |
Second Address | Lubbock, TX 79410-1307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2005 |
Last Update Date | 09/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103824205 | (05) | TX |
G48310 | (02) |