Provider Demographics
NPI:1063698645
Name:FAHED, SAMIR (MD)
Entity type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:
Last Name:FAHED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11226 SOUTHWEST FWY STE A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77031-3604
Mailing Address - Country:US
Mailing Address - Phone:832-486-9346
Mailing Address - Fax:832-553-7823
Practice Address - Street 1:11226 SOUTHWEST FWY STE A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77031-3604
Practice Address - Country:US
Practice Address - Phone:832-486-9346
Practice Address - Fax:832-553-7823
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2492208VP0014X
OH57-011358207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8GG132OtherBLUE CROSS BLUE SHIELD
TX549033ZN5TOtherMEDICARE
TX549033ZN5TOtherMEDICARE
TX8GG132OtherBLUE CROSS BLUE SHIELD