Provider Demographics
NPI:1023294527
Name:COLE, SAMUEL WARD (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:WARD
Last Name:COLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2610 S LAMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5243
Mailing Address - Country:US
Mailing Address - Phone:622-234-1731
Mailing Address - Fax:662-236-2392
Practice Address - Street 1:2610 SOUTH LAMAR BLVD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655
Practice Address - Country:US
Practice Address - Phone:662-234-1731
Practice Address - Fax:662-236-2392
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS21544207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09483701Medicaid
MS09483701Medicaid