Provider Demographics
NPI:1801862156
Name:SAMUEL, E. JOHN R (MD)
Entity type:Individual
Prefix:
First Name:E. JOHN
Middle Name:R
Last Name:SAMUEL
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 1:18955 N MEMORIAL DR
Mailing Address - Street 2:STE 200
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4386
Mailing Address - Country:US
Mailing Address - Phone:281-446-2999
Mailing Address - Fax:281-446-5399
Practice Address - Street 1:21848 HOLZWARTH RD STE 110
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-3454
Practice Address - Country:US
Practice Address - Phone:281-446-2999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6391207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127469801Medicaid
TXC11787Medicare UPIN
TX8F1811Medicare PIN