Provider Demographics
NPI:1639162936
Name:SAMORA-MATA, JOANN F (MD)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:F
Last Name:SAMORA-MATA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 FANNIN
Mailing Address - Street 2:1050
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-0000
Mailing Address - Country:US
Mailing Address - Phone:713-795-1004
Mailing Address - Fax:713-796-9485
Practice Address - Street 1:7400 FANNIN
Practice Address - Street 2:1050
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-0000
Practice Address - Country:US
Practice Address - Phone:713-795-1004
Practice Address - Fax:713-796-9485
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0238207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F22631Medicare PIN
TX8F9282Medicare PIN