Provider Demographics
NPI:1912205741
Name:HEARDMON, SAMUEL JAVAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:JAVAR
Last Name:HEARDMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:7333 NORTH FWY STE 122
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77076-1318
Mailing Address - Country:US
Mailing Address - Phone:713-694-3177
Mailing Address - Fax:713-695-5034
Practice Address - Street 1:7333 NORTH FWY STE 122
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77076-1318
Practice Address - Country:US
Practice Address - Phone:713-694-3177
Practice Address - Fax:713-695-5034
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8924208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics