Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | H4238 | TX |
Y | 208600000X | Surgeon | H4238 | TX |
NPI | 1013951763 |
---|---|
Provider Name | Dr. Andrew Charles Clemmons |
First Address | Victoria, TX 77901-6004 |
Second Address | Victoria, TX 77901-6004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4331024 | AETNA (01) | TX |
84251S | BLUECROSS BLUESHIELD (01) | TX |
D86908 | (02) | TX |