Provider Demographics
NPI:1356340368
Name:TURNER, SAMUEL K JR (DO)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:K
Last Name:TURNER
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 E 34TH ST
Mailing Address - Street 2:#101
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-3967
Mailing Address - Country:US
Mailing Address - Phone:417-782-3032
Mailing Address - Fax:
Practice Address - Street 1:702 E 34TH ST
Practice Address - Street 2:#101
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3967
Practice Address - Country:US
Practice Address - Phone:417-782-3032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5J96207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO12848OtherPROVIDER NUMBER
MO242641702Medicaid
000003569Medicare PIN
MO12848OtherPROVIDER NUMBER