Provider Demographics
NPI:1326049610
Name:ATTIA, SAMUEL L (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:L
Last Name:ATTIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SAMUEL
Other - Middle Name:L
Other - Last Name:ATTIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MB,CHB
Mailing Address - Street 1:3336 PLAINVIEW ST
Mailing Address - Street 2:STE 1460
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-1906
Mailing Address - Country:US
Mailing Address - Phone:713-790-0557
Mailing Address - Fax:713-790-0592
Practice Address - Street 1:3336 PLAINVIEW ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1906
Practice Address - Country:US
Practice Address - Phone:713-790-0557
Practice Address - Fax:713-790-0592
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE3526208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110141201Medicaid
B20997Medicare UPIN
TX00T168Medicare ID - Type Unspecified