Provider Demographics
NPI:1952311235
Name:SAMS, JEFFREY S (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
Last Name:SAMS
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 1:150 TAYLOR STATION RD
Mailing Address - Street 2:STE 290
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-4440
Mailing Address - Country:US
Mailing Address - Phone:614-755-9280
Mailing Address - Fax:614-755-9295
Practice Address - Street 1:150 TAYLOR STATION RD
Practice Address - Street 2:STE 290
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-4440
Practice Address - Country:US
Practice Address - Phone:614-755-9280
Practice Address - Fax:614-755-9295
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2022-12-23
Deactivation Date:2022-07-28
Deactivation Code:
Reactivation Date:2022-12-23
Provider Licenses
StateLicense IDTaxonomies
OH35055543207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0673589Medicaid
OH0673589Medicaid