MEDICARE: DR. SAMUEL BENJAMIN MAGNUS-LAWSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	G4344	TX

General Provider Information

NPI Number	:	1235160904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL BENJAMIN MAGNUS-LAWSON

Provider Business Mailing Address
First Line	:	1315 ST JOSEPH PKWY
Second Line	:	SUITE 1704
City	:	HOUSTON
State	:	TX
Zip	:	77002-8233
Country	:	US
Telephone Number	:	713-655-0303
Fax Number	:	713-655-0302

Provider Business Practice Location Address
First Line	:	1315 ST JOSEPH PKWY
Second Line	:	SUITE 1704
City	:	HOUSTON
State	:	TX
Zip	:	77002-8233
Country	:	US
Telephone Number	:	713-655-0303
Fax Number	:	713-655-0302

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	07/08/2010

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