Provider Demographics
NPI:1093277329
Name:DAUM, SAMANTHA (DO)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:DAUM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3300 PROVIDENCE DR STE B-104
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4690
Mailing Address - Country:US
Mailing Address - Phone:907-212-7997
Mailing Address - Fax:907-212-8225
Practice Address - Street 1:3300 PROVIDENCE DR STE B-104
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4690
Practice Address - Country:US
Practice Address - Phone:907-212-7997
Practice Address - Fax:907-212-8225
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL125074546207Q00000X
IL125-XXXXXX207Q00000X
MO2022002658207Q00000X
AK231231207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine