Provider Demographics
NPI:1922103290
Name:AWAD, SAMIR SAMUEL (MD)
Entity Type:Individual
Prefix:
First Name:SAMIR
Middle Name:SAMUEL
Last Name:AWAD
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 1:2002 HOLCOMBE BLVD
Mailing Address - Street 2:MED VAMC, OCL (112), RM 5A-344
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:713-794-7765
Mailing Address - Fax:713-794-7532
Practice Address - Street 1:2002 HOLCOMBE BLVD
Practice Address - Street 2:MED VAMC, OCL (112), RM 5A-344
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-794-7765
Practice Address - Fax:713-794-7532
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0007208600000X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Not Answered2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXZ000U33M4Medicaid
TXG43376Medicare UPIN
TXZ000U33M4Medicaid