Provider Demographics
NPI:1730340498
Name:SAMS, JACOB DAVID (MD)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:DAVID
Last Name:SAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9632
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62791-9632
Mailing Address - Country:US
Mailing Address - Phone:217-864-2665
Mailing Address - Fax:217-864-8042
Practice Address - Street 1:104 ASHLAND AVE.
Practice Address - Street 2:
Practice Address - City:MT. ZION
Practice Address - State:IL
Practice Address - Zip Code:62549
Practice Address - Country:US
Practice Address - Phone:217-864-2665
Practice Address - Fax:217-864-8042
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036132006207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery