Provider Demographics
NPI:1720162076
Name:SIEGLER,II, SAMUEL L (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:L
Last Name:SIEGLER,II
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 BINZ
Mailing Address - Street 2:SUITE 1300
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-6699
Mailing Address - Country:US
Mailing Address - Phone:713-526-8372
Mailing Address - Fax:713-526-8248
Practice Address - Street 1:1200 BINZ ST
Practice Address - Street 2:SUITE 1300
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-6900
Practice Address - Country:US
Practice Address - Phone:713-526-8372
Practice Address - Fax:713-526-8248
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4703207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE74411Medicare UPIN