Organization
CROSS CREEK MEDICAL PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WAYNE A SAMPSON MD (MEDICAL DIRECTOR)
(850) 877-6393
Entity
Organization
Contact information
Practice address
1381 CROSS CREEK CIR, SUITE A, TALLAHASSEE, FL 32301-3723
(850) 877-6393
(850) 877-6393
Mailing address
1381A CROSS CREEK CIR, TALLAHASSEE, FL 32301-3729
(850) 877-6393
(850) 877-6813
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0071014FLME
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003457000
—
FL
05
—
250984900
—
FL
01
—
DF9814
RAILROAD MEDICARE
FL
Enumeration date
02/01/2008
Last updated
10/05/2011
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