# DEBRA C SAMS DO

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073700837
- **Authorized official:** DEBRA C CRITES-SAMS DO (OWNER/PHYSICIAN)
- **Authorized official phone:** (304) 645-4406

## Contact information

- **Practice address:** 122 MAPLEWOOD AVENUE, RONCEVERTE, WV 24970
- **Practice address phone:** (304) 645-4406
- **Mailing address:** PO BOX 465, RONCEVERTE, WV 24970

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | E35409 | WV | Yes |

## Other

- **Enumeration date:** 09/26/2007
- **Last updated:** 11/27/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 3810010441 | — | WV |