Provider Demographics
NPI:1871571950
Name:LERMA, SAMMY III (MD)
Entity type:Individual
Prefix:
First Name:SAMMY
Middle Name:
Last Name:LERMA
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 664
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-0664
Mailing Address - Country:US
Mailing Address - Phone:512-321-3311
Mailing Address - Fax:512-321-2611
Practice Address - Street 1:1109 CHURCH ST
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-3206
Practice Address - Country:US
Practice Address - Phone:512-321-3311
Practice Address - Fax:512-321-2611
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6375207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0800674870OtherRAILROAD MEDICARE
TX139360508Medicaid
TX139360508Medicaid
TX0800674870OtherRAILROAD MEDICARE