Individual
DR. KENNETH M SAMPLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 BREWSTER BLVD, CAMP LEJEUNE, NC 28547-2575
(910) 450-4760
Mailing address
897 LYNCHBURG DR, JACKSONVILLE, NC 28546-6018
(910) 381-6942
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
0101253264
VA
208600000X
Surgery Physician
01053054A
IN
208600000X
Surgery Physician
Primary
24465
KY
Other
Enumeration date
02/14/2006
Last updated
02/12/2020
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