Healthcare Provider Details

I. General information

NPI: 1669509006
Provider Name (Legal Business Name): SAMUEL HAKIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10431 HIGHWAY 151 STE 180
SAN ANTONIO TX
78251-4551
US

IV. Provider business mailing address

7909 FREDERICKSBURG RD #110
SAN ANTONIO TX
78229-3425
US

V. Phone/Fax

Practice location:
  • Phone: 210-521-7333
  • Fax: 210-679-3735
Mailing address:
  • Phone: 210-614-4544
  • Fax: 210-679-3724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberM9337
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: