Provider Demographics
NPI:1649357773
Name:ROCHA, SAMUEL SOLIS (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:SOLIS
Last Name:ROCHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SAMUEL
Other - Middle Name:S
Other - Last Name:ROCHA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:13111 EAST FREEWAY
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77015-5810
Mailing Address - Country:US
Mailing Address - Phone:713-455-2301
Mailing Address - Fax:713-455-6245
Practice Address - Street 1:13111 EAST FREEWAY
Practice Address - Street 2:SUITE 203
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-5810
Practice Address - Country:US
Practice Address - Phone:713-455-2301
Practice Address - Fax:713-455-6245
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD6149207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8Z1560OtherBLUE CROSS BLUE SHIELD
C21178Medicare UPIN
TXK930Medicare ID - Type Unspecified