Provider Demographics
NPI:1235160904
Name:MAGNUS-LAWSON, SAMUEL BENJAMIN
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:BENJAMIN
Last Name:MAGNUS-LAWSON
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:BEN
Other - Middle Name:
Other - Last Name:MAGNUS-LAWSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1315 ST JOSEPH PKWY
Mailing Address - Street 2:SUITE 1704
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-8233
Mailing Address - Country:US
Mailing Address - Phone:713-655-0303
Mailing Address - Fax:713-655-0302
Practice Address - Street 1:1315 ST JOSEPH PKWY
Practice Address - Street 2:SUITE 1704
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-8233
Practice Address - Country:US
Practice Address - Phone:713-655-0303
Practice Address - Fax:713-655-0302
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4344207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00FQ32Medicare ID - Type UnspecifiedPROVIDER NUMBER