Provider Demographics
NPI:1861466708
Name:MATTAR, SAMER G (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMER
Middle Name:G
Last Name:MATTAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BAYLOR PLZ
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3498
Mailing Address - Country:US
Mailing Address - Phone:713-798-6673
Mailing Address - Fax:
Practice Address - Street 1:1977 BUTLER BLVD STE E6.100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4101
Practice Address - Country:US
Practice Address - Phone:171-379-8590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060735A208600000X
ORMD165024208600000X
TXS9030208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500668323Medicaid
INH37054Medicare UPIN
ORR173854Medicare PIN
INM400072850Medicare PIN