Healthcare Provider Details

I. General information

NPI: 1659506517
Provider Name (Legal Business Name): SAMPSON K KYERE JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2009
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 ELBRIDGE PAYNE RD STE 120
CHESTERFIELD MO
63017-8522
US

IV. Provider business mailing address

4061 POWDER MILL RD SUITE 210
CALVERTON MD
20705-3149
US

V. Phone/Fax

Practice location:
  • Phone: 314-238-5260
  • Fax: 314-821-1833
Mailing address:
  • Phone: 202-669-8501
  • Fax: 240-846-1490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD0071689
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number59997
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberD0071689
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: