Provider Demographics
NPI:1811188428
Name:JOHN W SAMPLES, MD,, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:JOHN W SAMPLES, MD,, A PROFESSIONAL CORPORATION
Other - Org Name:JOHN W SAMPLES, MD,PC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:SAMPLES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-496-7128
Mailing Address - Street 1:44489 TOWN CENTER WAY # D405
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92260-2723
Mailing Address - Country:US
Mailing Address - Phone:909-496-7128
Mailing Address - Fax:951-769-7481
Practice Address - Street 1:35400 BOB HOPE DR
Practice Address - Street 2:SUITE A 201
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-1772
Practice Address - Country:US
Practice Address - Phone:909-496-7128
Practice Address - Fax:951-769-7481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66241207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1265455935OtherIND. NPI
CAA66241OtherLICENSE
CABS6076788OtherDEA
CABS6076788OtherDEA
CAH18156Medicare UPIN