Provider Demographics
NPI:1487653622
Name:SAMUELS, DAVID ALEXANDER (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ALEXANDER
Last Name:SAMUELS
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 1:6400 FANNIN ST
Mailing Address - Street 2:# 3000
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1527
Mailing Address - Country:US
Mailing Address - Phone:713-790-0841
Mailing Address - Fax:713-790-1350
Practice Address - Street 1:6400 FANNIN ST
Practice Address - Street 2:# 3000
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1527
Practice Address - Country:US
Practice Address - Phone:713-790-0841
Practice Address - Fax:713-790-1350
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3598207RC0000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84G068OtherBCBS
TX060021728OtherRR MEDICARE
TX060051578OtherRAILROAD MEDICARE
TX118163801Medicaid
TX118163803Medicaid
TX83610KOtherBCBS
TX84G068Medicare PIN
TX84G068OtherBCBS
TX060021728Medicare PIN
TX83610KMedicare PIN