Provider Demographics
NPI:1174583215
Name:SAMPAT, KALA G (MD)
Entity type:Individual
Prefix:
First Name:KALA
Middle Name:G
Last Name:SAMPAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 W 1ST ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:BORGER
Mailing Address - State:TX
Mailing Address - Zip Code:79007-4001
Mailing Address - Country:US
Mailing Address - Phone:806-274-7111
Mailing Address - Fax:806-274-7113
Practice Address - Street 1:503 W 1ST ST
Practice Address - Street 2:SUITE B
Practice Address - City:BORGER
Practice Address - State:TX
Practice Address - Zip Code:79007-4001
Practice Address - Country:US
Practice Address - Phone:806-274-7111
Practice Address - Fax:806-274-7113
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF0661208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE81012Medicare UPIN