Basic Information
| Provider Information | |||||||||
| NPI: | 1427076744 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAMUELS | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 201088 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 772161088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135003500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6410 FANNIN ST | ||||||||
| Address2: | 606 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770303000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8323256545 | ||||||||
| FaxNumber: | 7135122247 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 02/12/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RA0000X | K1295 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | Adolescent Medicine | 207RN0300X | K1295 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 208000000X | K1295 | TX | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0210X | K1295 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 8F6692 | 01 | TX | BCBS | OTHER |