Provider Demographics
NPI:1902025000
Name:SAMER TAWAKKOL MD PA
Entity Type:Organization
Organization Name:SAMER TAWAKKOL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMER
Authorized Official - Middle Name:
Authorized Official - Last Name:TAWAKKOL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-293-8307
Mailing Address - Street 1:12121 RICHMOND AVE STE 408
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2439
Mailing Address - Country:US
Mailing Address - Phone:281-293-8307
Mailing Address - Fax:281-293-9984
Practice Address - Street 1:12121 RICHMOND AVE STE 408
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2439
Practice Address - Country:US
Practice Address - Phone:281-293-8307
Practice Address - Fax:281-293-9984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1762207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152347401Medicaid
TX152347401Medicaid
5329720001Medicare NSC