Provider Demographics
NPI:1790763456
Name:SAMO, TOBIAS (MD)
Entity Type:Individual
Prefix:
First Name:TOBIAS
Middle Name:
Last Name:SAMO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6560 FANNIN ST
Mailing Address - Street 2:SUITE 1540
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2761
Mailing Address - Country:US
Mailing Address - Phone:713-799-9997
Mailing Address - Fax:713-799-2511
Practice Address - Street 1:6560 FANNIN ST
Practice Address - Street 2:SUITE 1540
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2761
Practice Address - Country:US
Practice Address - Phone:713-799-9997
Practice Address - Fax:713-799-2511
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF4471207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128174304Medicaid
TX128174304Medicaid
TX83G894Medicare PIN