MEDICARE: DR. SAMUEL JAVAR HEARDMON MD

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	208000000X	Pediatrics Physician	N8924	TX

General Provider Information

NPI Number	:	1912205741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL JAVAR HEARDMON MD

Provider Business Mailing Address
First Line	:	7333 NORTH FWY STE 122
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77076-1318
Country	:	US
Telephone Number	:	713-694-3177
Fax Number	:	713-695-5034

Provider Business Practice Location Address
First Line	:	7333 NORTH FWY STE 122
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77076-1318
Country	:	US
Telephone Number	:	713-694-3177
Fax Number	:	713-695-5034

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

Provider Enumeration Date	:	03/02/2011
Last Update Date	:	03/17/2018

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