Basic Information
| Provider Information | |||||||||
| NPI: | 1508037334 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SAMUEL | ||||||||
| FirstName: | JOYCE | ||||||||
| MiddleName: | PHILIP | ||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | PHILIP | ||||||||
| OtherFirstName: | JOYCE | ||||||||
| OtherMiddleName: | ANNE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 6431 FANNIN ST | ||||||||
| Address2: | MSB 3.121 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770301501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135005670 | ||||||||
| FaxNumber: | 7135005680 | ||||||||
| Practice Location | |||||||||
| Address1: | 6431 FANNIN ST | ||||||||
| Address2: | MSB 3.121 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770301501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135005670 | ||||||||
| FaxNumber: | 7135005680 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2008 | ||||||||
| LastUpdateDate: | 11/01/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | M8971 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 198985705 (MDACC) | 05 | TX | MEDICAID | 8DU079 | 01 | TX | BCBS (MDACC) | OTHER | 198985706 | 01 | TX | MEDICAID CSHCN MDACC | OTHER |