Individual
ROBIN RENEE SAMFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LSA
Contact information
Practice address
540 W 5TH ST STE 470, ODESSA, TX 79761-5070
(432) 580-8330
(432) 580-8333
Mailing address
540 W 5TH STREET #470, ODESSA, TX 79761
(432) 580-8330
(432) 580-8333
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
SA00093
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00455Q
MEDICARE PROVIDER ID
TX
01
—
071693
NATNL CERT SURGICAL TECH
TX
01
—
83628
NAT CERT SURGICAL TECH
TX
01
—
8F0641
BLUE CROSS PROVIDER #
—
01
—
SA00093
TEXAS STATE BOARD OF MEDI
TX
Enumeration date
08/07/2006
Last updated
11/12/2007
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