Basic Information
| Provider Information | |||||||||
| NPI: | 1093907750 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAMUEL J. KASBERG, M.D., P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 223 S ABE ST | ||||||||
| Address2: | |||||||||
| City: | SAN ANGELO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 769036305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3256557969 | ||||||||
| FaxNumber: | 3256557976 | ||||||||
| Practice Location | |||||||||
| Address1: | 3501 KNICKERBOCKER RD | ||||||||
| Address2: | |||||||||
| City: | SAN ANGELO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 769047610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3259499511 | ||||||||
| FaxNumber: | 3256557976 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2007 | ||||||||
| LastUpdateDate: | 08/15/2007 | ||||||||
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| AuthorizedOfficialLastName: | KASBERG | ||||||||
| AuthorizedOfficialFirstName: | SAMUEL | ||||||||
| AuthorizedOfficialMiddleName: | JOSEPH | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN/CEO | ||||||||
| AuthorizedOfficialTelephone: | 3256557969 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0005X | J3826 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | Undersea and Hyperbaric Medicine |
ID Information
| ID | Type | State | Issuer | Description | J3826 | 01 | TX | TEXAS LICENSE | OTHER |