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NPI Code Detail

MEDICARE: DR. TODD E. SAMUELSON M.D.

MEDICARE: DR. TODD E. SAMUELSON M.D.
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
1207Y00000XOtolaryngology PhysicianH2007TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P01034921OTHERTXRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1942308119
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TODD E. SAMUELSON M.D.
Provider Business Mailing Address
First Line : PO BOX 961205
Second Line :
City : FORT WORTH
State : TX
Zip : 76161-1205
Country : US
Telephone Number : 817-740-8400
Fax Number : 817-926-2531
Provider Business Practice Location Address
First Line : 1250 8TH AVE
Second Line : SUITE 205
City : FORT WORTH
State : TX
Zip : 76104-4158
Country : US
Telephone Number : 817-335-8151
Fax Number : 817-926-2531
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 06/21/2012

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