Basic Information
| Provider Information | |||||||||
| NPI: | 1205026390 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LIGHTSEY | ||||||||
| FirstName: | SAMUEL | ||||||||
| MiddleName: | HOPKINS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4050 E HILL DR | ||||||||
| Address2: | |||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750386211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8174759740 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1901 N MACARTHUR BLVD | ||||||||
| Address2: | |||||||||
| City: | IRVING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750612220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725798100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2007 | ||||||||
| LastUpdateDate: | 02/26/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | P3758 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 2006007896 | MO | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.