Provider Demographics
NPI:1457795676
Name:SAMUELSON, CHRISTIAN G (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:G
Last Name:SAMUELSON
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 1:12702 TOEPPERWEIN RD STE 104
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3266
Mailing Address - Country:US
Mailing Address - Phone:210-664-4446
Mailing Address - Fax:210-664-4447
Practice Address - Street 1:12702 TOEPPERWEIN RD STE 104
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3266
Practice Address - Country:US
Practice Address - Phone:210-664-4446
Practice Address - Fax:210-664-4447
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-18
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR0118207L00000X, 207LP2900X, 208VP0014X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program