Provider Demographics
NPI:1790459527
Name:HOBBS, SAMUEL DEWAINE
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:DEWAINE
Last Name:HOBBS
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 1:14525 FM 529 RD STE 200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-3596
Mailing Address - Country:US
Mailing Address - Phone:910-441-9334
Mailing Address - Fax:832-426-7715
Practice Address - Street 1:14525 FM 529 RD STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-3596
Practice Address - Country:US
Practice Address - Phone:910-441-9334
Practice Address - Fax:832-426-7715
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1744P3200X
TX83054101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1744P3200XOther Service ProvidersSpecialistProsthetics Case Management