Provider Demographics
NPI:1689803520
Name:J YASON SAMSON MD PC
Entity Type:Organization
Organization Name:J YASON SAMSON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNAL MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEFINA
Authorized Official - Middle Name:YASON
Authorized Official - Last Name:SAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-263-0597
Mailing Address - Street 1:225 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1539
Mailing Address - Country:US
Mailing Address - Phone:517-263-0597
Mailing Address - Fax:517-263-0598
Practice Address - Street 1:225 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1539
Practice Address - Country:US
Practice Address - Phone:517-263-0597
Practice Address - Fax:517-263-0598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJY030835207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2914962Medicaid
MI0462930Medicare PIN
MI2914962Medicaid