Bruce Michael Samson, MD
Individual provider Active NPI General Practice Physician · Osakis, MN
NPI 1962708503 · NPPES record last updated Aug 18, 2015
Key facts
- NPI
- 1962708503
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Physician 208D00000X
- License
- 023083 (MN)
- Practice address
- 13234 Fawn Dr
Osakis, MN 56360-4858 - Phone
- (952) 240-9298
- Fax
- (952) 955-1970
- NPI assigned
- Jan 30, 2011
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 023083 | MN | MD | General Practice Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 023083 | MN | Yes |
Addresses
Primary practice location
13234 Fawn Dr
Osakis, MN 56360-4858
Mailing address
13234 Fawn Dr
Osakis, MN 56360-4858
Phone (952) 240-9298
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All providers in Osakis, MN · General Practice Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 18, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.