Provider Demographics
NPI:1689937906
Name:EDIAE, SAMSON
Entity Type:Individual
Prefix:
First Name:SAMSON
Middle Name:
Last Name:EDIAE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9630 CLAREWOOD DR
Mailing Address - Street 2:SUITE B-6
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-3512
Mailing Address - Country:US
Mailing Address - Phone:713-271-2066
Mailing Address - Fax:713-271-2088
Practice Address - Street 1:9630 CLAREWOOD DR
Practice Address - Street 2:SUITE B-6
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-3512
Practice Address - Country:US
Practice Address - Phone:713-271-2066
Practice Address - Fax:713-271-2088
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10007443416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport