Provider Demographics
NPI:1306897582
Name:SAMPSON, WAYNE ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:ANTHONY
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 1:1381A CROSS CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-3729
Mailing Address - Country:US
Mailing Address - Phone:850-877-6393
Mailing Address - Fax:850-877-6813
Practice Address - Street 1:1381A CROSS CREEK CIR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-3729
Practice Address - Country:US
Practice Address - Phone:850-877-6393
Practice Address - Fax:850-877-6813
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-13
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0071014207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250984900Medicaid
FL003457000Medicaid
DC32877OtherBC/BS OF FLORIDA
FL071018Medicaid
FL07549OtherUNIVERSAL HEALTHPLAN
FLG87169Medicare UPIN
FL071018Medicaid