Healthcare Provider Details

I. General information

NPI: 1861466708
Provider Name (Legal Business Name): SAMER G MATTAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1977 BUTLER BLVD STE E6.100
HOUSTON TX
77030-4101
US

IV. Provider business mailing address

1 BAYLOR PLZ
HOUSTON TX
77030-3498
US

V. Phone/Fax

Practice location:
  • Phone: 171-379-8590
  • Fax:
Mailing address:
  • Phone: 713-798-6673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01060735A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License NumberS9030
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD165024
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberS9030
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: