MEDICARE: BRADLEY C SAMS MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	16666	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144635947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRADLEY C SAMS MD PA

Provider Business Mailing Address
First Line	:	1001 N HALSTEAD RD
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-3121
Country	:	US
Telephone Number	:	228-861-8658
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 N HALSTEAD RD
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-3121
Country	:	US
Telephone Number	:	228-861-8658
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BRADLEY CARNELL SAMS
Credential	:	MD
Telephone Number	:	228-818-0416

Provider Enumeration Date	:	07/01/2014
Last Update Date	:	07/01/2014

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