Organization
SALLY SAMPLE MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SALLY SAMPLE M.D. (MEDICAL DOCTOR)
(530) 220-0176
Entity
Organization
Contact information
Practice address
658 BIANCO CT, DAVIS, CA 95616-0608
(530) 220-0176
Mailing address
658 BIANCO CT, DAVIS, CA 95616-0608
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
02/24/2015
Last updated
02/24/2015
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