Provider Demographics
NPI:1871560573
Name:HOUSTON, SAMUEL THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:THOMAS
Last Name:HOUSTON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:704 W GROVE ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730-4416
Mailing Address - Country:US
Mailing Address - Phone:870-863-4511
Mailing Address - Fax:870-863-4525
Practice Address - Street 1:704 W GROVE ST
Practice Address - Street 2:SUITE 4
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4416
Practice Address - Country:US
Practice Address - Phone:870-863-4511
Practice Address - Fax:870-863-4525
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2025-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARR4005208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR4207224OtherAETNA
AR129320000OtherQUALCHOICE
AR119065001Medicaid
AR119065001Medicaid
AR340009254Medicare PIN
ARE84562Medicare UPIN