MEDICARE: DR. SAMIR RUXMOHAN DO

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	2084A2900X	Neurocritical Care Physician	8874	OK
2	2084A2900X	Neurocritical Care Physician	T7020	TX
3	2084N0400X	Neurology Physician	8874	OK
4	2084N0400X	Neurology Physician	T7020	TX

General Provider Information

NPI Number	:	1639670037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMIR RUXMOHAN DO

Provider Business Mailing Address
First Line	:	5605 N MACARTHUR BLVD STE 525
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75038-2617
Country	:	US
Telephone Number	:	214-960-5681
Fax Number	:	214-960-5681

Provider Business Practice Location Address
First Line	:	221 W COLORADO BLVD
Second Line	:	PAVILLION 2, SUITE 525
City	:	DALLAS
State	:	TX
Zip	:	75208
Country	:	US
Telephone Number	:	214-960-5681
Fax Number	:

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

Provider Enumeration Date	:	02/22/2018
Last Update Date	:	06/09/2026

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