MEDICARE: SAMER TAWAKKOL MD PA

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	207XP3100X	Pediatric Orthopaedic Surgery Physician	L1762	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902025000
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMER TAWAKKOL MD PA

Provider Business Mailing Address
First Line	:	12121 RICHMOND AVE STE 408
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-2439
Country	:	US
Telephone Number	:	281-293-8307
Fax Number	:	281-293-9984

Provider Business Practice Location Address
First Line	:	12121 RICHMOND AVE STE 408
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-2439
Country	:	US
Telephone Number	:	281-293-8307
Fax Number	:	281-293-9984

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SAMER TAWAKKOL
Credential	:	MD
Telephone Number	:	281-293-8307

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	05/21/2014

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