Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Om Sam, MD

Individual provider Family Medicine Physician · NPI 1457845588

Om Sam, MD is a Family Medicine Physician in Sullivan, Missouri. Works from 2 locations. Licensed in Missouri.

Licensed in
MO
In the registry since
2018
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

965 Mattox Dr
Sullivan, MO 63080-2365
Phone: (573) 860-6000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 507 Main St, Johnson City, NY 13790-1810 — (607) 763-6075

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 2021026443 (MO)

Record details

NPI number1457845588
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedJune 21, 2018
Last updated in NPPESJuly 29, 2021
Certification dateJuly 29, 2021
Mailing address965 Mattox Dr, Sullivan, MO 63080-2365

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