Individual
SAMIR SANMUKH DESAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1901 LONG PRAIRIE RD STE 220-80, FLOWER MOUND, TX 75022-4246
(940) 736-6810
Mailing address
1901 LONG PRAIRIE RD, FLOWER MOUND, TX 75022-4246
(940) 736-6810
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA04166
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8L22891
MEDICARE PTAN #
TX
01
—
PA04166
LICENSE NUMBER
TX
Enumeration date
06/28/2006
Last updated
09/26/2018
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