Provider Demographics
NPI:1831199108
Name:SAMSON, STUART (MD)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:
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:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39441-0247
Mailing Address - Country:US
Mailing Address - Phone:601-426-9614
Mailing Address - Fax:601-399-1592
Practice Address - Street 1:5 DUNNBARR
Practice Address - Street 2:SUITE 1
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-1041
Practice Address - Country:US
Practice Address - Phone:601-426-9614
Practice Address - Fax:601-399-1592
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS209922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05679044Medicaid
MS302I264194Medicare Oscar/Certification
MS347627YZY3Medicare PIN
MS05679044Medicaid