Provider Demographics
NPI:1508037334
Name:SAMUEL, JOYCE PHILIP (MD)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:PHILIP
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JOYCE
Other - Middle Name:ANNE
Other - Last Name:PHILIP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6431 FANNIN ST
Mailing Address - Street 2:MSB 3.121
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1501
Mailing Address - Country:US
Mailing Address - Phone:713-500-5670
Mailing Address - Fax:713-500-5680
Practice Address - Street 1:6431 FANNIN ST
Practice Address - Street 2:MSB 3.121
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1501
Practice Address - Country:US
Practice Address - Phone:713-500-5670
Practice Address - Fax:713-500-5680
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8971208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX198985705 (MDACC)Medicaid
TX8DU079OtherBCBS (MDACC)
TX198985706OtherMEDICAID CSHCN MDACC