Provider Demographics
NPI:1730175944
Name:DIASTI, SAM (MD)
Entity type:Individual
Prefix:
First Name:SAM
Middle Name:
Last Name:DIASTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2605 W SWANN AVE
Mailing Address - Street 2:STE. 100
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4039
Mailing Address - Country:US
Mailing Address - Phone:813-874-5500
Mailing Address - Fax:813-874-5505
Practice Address - Street 1:2605 W SWANN AVE
Practice Address - Street 2:STE. 100
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4039
Practice Address - Country:US
Practice Address - Phone:713-874-5500
Practice Address - Fax:813-874-5505
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2020-12-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME71925207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00252915Medicare PIN
FLK6869Medicare PIN