Provider Demographics
NPI:1316022148
Name:HARDEN, SAMUEL JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:JAMES
Last Name:HARDEN
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 1:2501 JIMMY JOHNSON STE 205
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77640-2009
Mailing Address - Country:US
Mailing Address - Phone:706-582-2344
Mailing Address - Fax:706-582-2344
Practice Address - Street 1:415 N AVENUE F
Practice Address - Street 2:
Practice Address - City:DENVER CITY
Practice Address - State:TX
Practice Address - Zip Code:79323-2741
Practice Address - Country:US
Practice Address - Phone:806-592-9501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0746208600000X
AL00017674208600000X
WI18392208600000X
NMMD2023-0268208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMPENDINGMedicaid
AL00017674OtherSTATE LICENSE
WI100095706Medicaid