MEDICARE: IRENE SAMUEL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ML60661168	WA
2	207Q00000X	Family Medicine Physician	U6796	TX

General Provider Information

NPI Number	:	1245687862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRENE SAMUEL M.D.

Provider Business Mailing Address
First Line	:	2220 E LEAGUE CITY PKWY STE 200
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-2100
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2220 E LEAGUE CITY PKWY STE 200
Second Line	:
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-2100
Country	:	US
Telephone Number	:	281-523-3110
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2016
Last Update Date	:	03/09/2026

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