Individual
SAMRET YAUKOOLBODI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 HIGH ST, BUFFALO, NY 14203-1126
(716) 852-1977
(716) 859-7388
Mailing address
100 HIGH ST, STE B252, BUFFALO, NY 14203-1126
(716) 852-1977
(716) 859-7388
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
Primary
137351
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00025409601
UNIVERA
—
01
—
00025409602
UNIVERA
—
01
—
000525482004
BLUE SHIELD WESTERN NY
—
05
—
00486508
—
NY
01
—
300122352
RAILROAD MEDICARE
—
01
—
5608983
INDEPENDENT HEALTH
—
01
—
CRDRA1373513
WORKERS COMPENSATION
—
Enumeration date
07/23/2006
Last updated
02/10/2012
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