Provider Demographics
NPI:1700852068
Name:E. JOHN R. SAMUEL, MD, PA
Entity Type:Organization
Organization Name:E. JOHN R. SAMUEL, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:E. JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SAMUEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-446-2999
Mailing Address - Street 1:18955 N MEMORIAL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4386
Mailing Address - Country:US
Mailing Address - Phone:281-446-2999
Mailing Address - Fax:281-446-5399
Practice Address - Street 1:18955 N MEMORIAL DR STE 200
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-4386
Practice Address - Country:US
Practice Address - Phone:281-446-9999
Practice Address - Fax:281-446-5399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-27
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY257051207RC0000X
TXG7326207RH0000X, 207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematologyGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00866ZMedicare PIN