Provider Demographics
NPI:1891861506
Name:SAMSON, BIENVENIDO T (MD)
Entity Type:Individual
Prefix:
First Name:BIENVENIDO
Middle Name:T
Last Name:SAMSON
Suffix:
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 1:755 E MCMURRY BLVD
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37074-2041
Mailing Address - Country:US
Mailing Address - Phone:615-374-4477
Mailing Address - Fax:615-374-4476
Practice Address - Street 1:755 E MCMURRY BLVD
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37074-2041
Practice Address - Country:US
Practice Address - Phone:615-374-4477
Practice Address - Fax:615-374-4476
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000025108208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0140513OtherUNITED HEALTHCARE
TN0177455OtherBLUE CROSS
TN3080438Medicaid
TN0177455OtherBLUE CROSS
B36898Medicare UPIN