Provider Demographics
NPI:1558452144
Name:STOKES, SAM III (MD)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:
Last Name:STOKES
Suffix:III
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:PO BOX 3988
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62902-3988
Mailing Address - Country:US
Mailing Address - Phone:618-457-5200
Mailing Address - Fax:
Practice Address - Street 1:305 W JACKSON ST STE 301
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-1474
Practice Address - Country:US
Practice Address - Phone:618-351-9300
Practice Address - Fax:618-351-9307
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036089297208800000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDA7587OtherRAILROAD MEDICARE GROUP
IL036089297Medicaid
ILP00070868OtherRAILROAD MEDICARE PIN
ILG80608OtherUPIN #
IL03932016OtherBCBS OF ILLINOIS
IL632586OtherHEALTHLINK
IL090870OtherHEALTH ALLIANCE
ILK03797Medicare PIN
ILK06918Medicare PIN
IL632586OtherHEALTHLINK
IL03932016OtherBCBS OF ILLINOIS
IL036089297Medicaid
IL214881Medicare Oscar/Certification