Healthcare Provider Details

I. General information

NPI: 1457884082
Provider Name (Legal Business Name): SAMEER PRAKASH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2017
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9250 PINECROFT DR STE N2.101
SHENANDOAH TX
77380-3218
US

IV. Provider business mailing address

909 FROSTWOOD DR STE 1.100
HOUSTON TX
77024-2301
US

V. Phone/Fax

Practice location:
  • Phone: 713-897-2307
  • Fax:
Mailing address:
  • Phone: 713-338-5519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberT0602
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDO-05602
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberDO-05602
License Number StateIA
# 4
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberT0602
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: