Healthcare Provider Details

I. General information

NPI: 1588056170
Provider Name (Legal Business Name): TERRI-ANN SAMUELS MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2015
Last Update Date: 11/29/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6750 WEST LOOP S
BELLAIRE TX
77401-4103
US

IV. Provider business mailing address

2171 UNIVERSITY BLVD
HOUSTON TX
77030-1218
US

V. Phone/Fax

Practice location:
  • Phone: 832-831-0362
  • Fax: 866-313-7527
Mailing address:
  • Phone: 347-661-2324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License NumberN7746
License Number StateTX

VIII. Authorized Official

Name: DR. TERRI-ANN PATRICIA SAMUELS
Title or Position: OWNER
Credential: MD
Phone: 832-831-0362