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General NPI Number Information
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NPI Number | 1750061784
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Entity Type | Individual
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Provider Name | SAMER DA SHAMOUT MD
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Gender | Male
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Dates
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Enumeration Date | 07/24/2023
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Last Update Date | 08/24/2023
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Provider Practice Location Address
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Address Line | 2401 S 31ST ST # MS 29C269
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City | TEMPLE
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State | TX
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Zip | 76508-0001
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Country | US
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Telephone | 514-806-2966
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 844658
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City | DALLAS
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State | TX
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Zip | 75284-4658
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Country | US
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Telephone | 254-724-2111
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2088F0040X
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Taxonomy Name | Urogynecology and Reconstructive Pelvic Surgery (Urology) Physician
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License Number | 47906
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2088P0231X
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Taxonomy Name | Pediatric Urology Physician
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License Number | 47906
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 47906
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License Number State | TX
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