Provider Demographics
NPI:1003838699
Name:SAMS, LUCIUS F III (MD)
Entity Type:Individual
Prefix:
First Name:LUCIUS
Middle Name:F
Last Name:SAMS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:965 RIDGE LAKE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9446
Mailing Address - Country:US
Mailing Address - Phone:901-227-3255
Mailing Address - Fax:901-227-3205
Practice Address - Street 1:3011 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-8712
Practice Address - Country:US
Practice Address - Phone:601-825-9000
Practice Address - Fax:601-825-2513
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS11081207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00119501Medicaid
MS00119501Medicaid
202878785OtherFORTIS
P00267519OtherMCARE RAILROAD
202878785OtherGILSBAR
202878785OtherAETNA
202878785OtherFORTIS