Provider Demographics
NPI:1033346366
Name:JAMES, CLEVE O (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:CLEVE
Middle Name:O
Last Name:JAMES
Suffix:
Gender:M
Credentials:MD, PHD
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 5666
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77508-5666
Mailing Address - Country:US
Mailing Address - Phone:832-831-3478
Mailing Address - Fax:832-831-3489
Practice Address - Street 1:4102 WOODLAWN AVE
Practice Address - Street 2:STE 110
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1921
Practice Address - Country:US
Practice Address - Phone:832-831-3478
Practice Address - Fax:832-831-3489
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2019-11-08
Deactivation Date:2019-10-24
Deactivation Code:
Reactivation Date:2019-11-07
Provider Licenses
StateLicense IDTaxonomies
MDP23933207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX447551Medicare PIN