Provider Demographics
NPI:1871931667
Name:WAIRIRI, SAM (MD)
Entity type:Individual
Prefix:
First Name:SAM
Middle Name:
Last Name:WAIRIRI
Suffix:
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 1:1458 GROVE MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3307
Mailing Address - Country:US
Mailing Address - Phone:650-863-1135
Mailing Address - Fax:
Practice Address - Street 1:1458 GROVE MEADOW CT
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3307
Practice Address - Country:US
Practice Address - Phone:650-863-1135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN219642085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology