Provider Demographics
NPI:1699867044
Name:DAS, SAMIRAN K (MD)
Entity type:Individual
Prefix:
First Name:SAMIRAN
Middle Name:K
Last Name:DAS
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:PO BOX 58664
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77258
Mailing Address - Country:US
Mailing Address - Phone:713-936-1014
Mailing Address - Fax:713-936-1015
Practice Address - Street 1:3333 BAYSHORE BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504
Practice Address - Country:US
Practice Address - Phone:713-936-1014
Practice Address - Fax:713-936-1015
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4752207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02621781Medicaid
TX186123902Medicaid
TX186123902Medicaid
NY02621781Medicaid