Provider Demographics
NPI:1578660015
Name:DAHDAL, SAMIR Y (MD)
Entity type:Individual
Prefix:
First Name:SAMIR
Middle Name:Y
Last Name:DAHDAL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3709 N CAMPBELL AVE
Mailing Address - Street 2:STE 135
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-1565
Mailing Address - Country:US
Mailing Address - Phone:520-838-3540
Mailing Address - Fax:520-838-2348
Practice Address - Street 1:5140 E GLENN ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1337
Practice Address - Country:US
Practice Address - Phone:520-838-3540
Practice Address - Fax:520-325-3526
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2021-10-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA90652207RC0000X
AZ35850207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
I08543Medicare UPIN