Provider Demographics
NPI:1811941529
Name:SAMS, WILLIAM C III (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
Last Name:SAMS
Suffix:III
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:PO BOX 148
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39502-0148
Mailing Address - Country:US
Mailing Address - Phone:228-864-2633
Mailing Address - Fax:228-865-0339
Practice Address - Street 1:1900 23RD AVE
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2965
Practice Address - Country:US
Practice Address - Phone:228-864-2633
Practice Address - Fax:228-865-0339
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07263207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00014902Medicaid
MSC48330Medicare UPIN
MS00014902Medicaid