Individual
SCOTT A. SAMPLE
Active
Individual
SCOTT A. SAMPLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
Primary
2020-00954
NC
207RI0011X
Interventional Cardiology Physician
MED-PHYS-LIC-10527
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000096785
BCBS PIN
MT
01
—
0072607
MDCD PIN
MT
01
—
119419400
MDCD PIN
WY
Enumeration date
10/23/2006
Last updated
04/02/2020
Update your record
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