Provider Demographics
NPI:1922019579
Name:SAMUEL, VARUGHESE PUTHENPARAMPIL (MD)
Entity type:Individual
Prefix:DR
First Name:VARUGHESE
Middle Name:PUTHENPARAMPIL
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 1:1113 ELLIS AVE
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3346
Mailing Address - Country:US
Mailing Address - Phone:936-637-2888
Mailing Address - Fax:936-634-2321
Practice Address - Street 1:1113 ELLIS AVE
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3346
Practice Address - Country:US
Practice Address - Phone:936-637-2888
Practice Address - Fax:936-634-2321
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5965207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00702NOtherMEDICARE GROUP NUMBER
TX00702NOtherMEDICARE GROUP NUMBER
E67738Medicare UPIN