Provider Demographics
NPI:1548681042
Name:GATZERT, SAMUEL THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:THOMAS
Last Name:GATZERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SAM
Other - Middle Name:THOMAS
Other - Last Name:GATZERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5667
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75505-5667
Mailing Address - Country:US
Mailing Address - Phone:903-223-1014
Mailing Address - Fax:903-223-1028
Practice Address - Street 1:2600 SAINT MICHAEL DR
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-2372
Practice Address - Country:US
Practice Address - Phone:903-223-1014
Practice Address - Fax:903-223-1028
Is Sole Proprietor?:No
Enumeration Date:2013-12-31
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100492452085R0202X
TXQ61912085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology