Provider Demographics
NPI:1831196427
Name:SATO, SAM EDWIN (MD)
Entity type:Individual
Prefix:DR
First Name:SAM
Middle Name:EDWIN
Last Name:SATO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6440 N THIMBLE PASS
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-1321
Mailing Address - Country:US
Mailing Address - Phone:520-529-1917
Mailing Address - Fax:
Practice Address - Street 1:3910 N CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-1428
Practice Address - Country:US
Practice Address - Phone:520-323-2466
Practice Address - Fax:520-323-2968
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14758207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ02719OtherTRICARE
AZ02719OtherUNITED HEALTHCARE
AZ005302638OtherCIGNA
AZ1Z2321OtherHEALTHNET
AZ247751Medicaid
AZAZ0181600OtherBLUE CROSS
AZD37582Medicare UPIN
AZ1Z2321OtherHEALTHNET