Provider Demographics
NPI:1922103464
Name:SAM, MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:SAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:211 HIGHLAND CROSS DR
Mailing Address - Street 2:SUITE 275
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77073-1733
Mailing Address - Country:US
Mailing Address - Phone:281-784-1500
Mailing Address - Fax:281-209-8930
Practice Address - Street 1:211 HIGHLAND CROSS DR
Practice Address - Street 2:SUITE 275
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77073-1733
Practice Address - Country:US
Practice Address - Phone:281-784-1500
Practice Address - Fax:281-209-8930
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME87641207P00000X
TXN4716207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CE878OtherBLUE CROSS BLUE SHIELD
TX209684402Medicaid
TX1922103464OtherTRICARE
TX209684402Medicaid