=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013973163
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SOLOMON SAM BRICKMAN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2006
-----------------------------------------------------
Last Update Date | 02/29/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11730 FM 1960 RD W
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77065-3514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-955-2263
-----------------------------------------------------
Fax | 281-955-7990
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11730 FM 1960 RD W
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77065-3514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-955-2263
-----------------------------------------------------
Fax | 281-955-7990
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | F2179
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | F2179
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------