Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 3490 | TN |
Y | 207PP0204X | Pediatric Emergency Physician | 2021019452 | MO |
N | 208000000X | Pediatrician | 3490 | TN |
NPI | 1770960288 |
---|---|
Provider Name | Megan Sampson |
First Address | Springfield, MO 65804-2203 |
Second Address | Springfield, MO 65804-2203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2015 |
Last Update Date | 24/06/2021 |