Provider Demographics
NPI:1437122587
Name:HOCHANE, SAM (MD)
Entity type:Individual
Prefix:
First Name:SAM
Middle Name:
Last Name:HOCHANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1149
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85929-1149
Mailing Address - Country:US
Mailing Address - Phone:928-532-2242
Mailing Address - Fax:928-532-6351
Practice Address - Street 1:5171 CUB LAKE RD
Practice Address - Street 2:BLDG C SUITE 340
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7888
Practice Address - Country:US
Practice Address - Phone:928-532-2242
Practice Address - Fax:928-532-3006
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ320922084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ851130Medicaid
AZ103243Medicare PIN
AZ851130Medicaid