Healthcare Provider Details

I. General information

NPI: 1306161211
Provider Name (Legal Business Name): SAMANTHA JANE ROBARE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SAMANTHA JANE ROBARE-STOUT MD

II. Dates (important events)

Enumeration Date: 04/02/2010
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10547 FRY RD
CYPRESS TX
77433-5348
US

IV. Provider business mailing address

10547 FRY RD
CYPRESS TX
77433-5348
US

V. Phone/Fax

Practice location:
  • Phone: 832-834-3349
  • Fax:
Mailing address:
  • Phone: 832-834-3349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberP4806
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: