Basic Information
| Provider Information | |||||||||
| NPI: | 1437234440 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZALLOUM | ||||||||
| FirstName: | SAMEEH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14100 SAN PEDRO AVE STE 412 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782322009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105437334 | ||||||||
| FaxNumber: | 2103145044 | ||||||||
| Practice Location | |||||||||
| Address1: | 6520 N PRESIDENT GEORGE BUSH HWY | ||||||||
| Address2: | |||||||||
| City: | GARLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729714223 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2006 | ||||||||
| LastUpdateDate: | 05/30/2019 | ||||||||
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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 | 207P00000X | K7126 | TX | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 208000000X | K7126 | TX | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0204X | K7126 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 50470825 | 05 | NM | MEDICAID | 930110042 | 01 | TX | RAILROAD MEDICARE | OTHER | 117078906 | 05 | TX | MEDICAID | 8A8647 | 01 | TX | BCBS | OTHER | 1437234440 | 01 | TX | CSHCN | OTHER |