Provider Demographics
NPI:1699881821
Name:SAMPSON, MATTHEW (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
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 1:1492 S 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAFFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85546-4052
Mailing Address - Country:US
Mailing Address - Phone:928-348-2151
Mailing Address - Fax:928-428-3617
Practice Address - Street 1:1492 S 20TH AVE
Practice Address - Street 2:
Practice Address - City:SAFFORD
Practice Address - State:AZ
Practice Address - Zip Code:85546-4052
Practice Address - Country:US
Practice Address - Phone:928-348-2151
Practice Address - Fax:928-428-3617
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ41760207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine