Provider Demographics
NPI: | 1720158553 |
---|---|
Name: | SAMPSON, JOHN (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | JOHN |
Middle Name: | |
Last Name: | SAMPSON |
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: | 2100 ERWIN RD |
Mailing Address - Street 2: | DUKE UNIVERSITY MEDICAL CENTER - DUMC 3050 |
Mailing Address - City: | DURHAM |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 27710-0001 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 919-684-9041 |
Mailing Address - Fax: | 919-684-9045 |
Practice Address - Street 1: | 2100 ERWIN RD |
Practice Address - Street 2: | DUKE UNIVERSITY MEDICAL CENTER - DUMC 3050 |
Practice Address - City: | DURHAM |
Practice Address - State: | NC |
Practice Address - Zip Code: | 27710-0001 |
Practice Address - Country: | US |
Practice Address - Phone: | 919-684-9041 |
Practice Address - Fax: | 919-684-9045 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-11-09 |
Last Update Date: | 2013-05-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | 96-00716 | 207T00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NC | 8911353 | Medicare ID - Type Unspecified | |
G68597 | Medicare ID - Type Unspecified | ||
NC | 2253415A | Medicare ID - Type Unspecified |