Provider Demographics
NPI:1073501045
Name:PEDRICK, CLAYTON B (MD)
Entity Type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:B
Last Name:PEDRICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7900 FANNIN ST
Mailing Address - Street 2:SUITE 2300
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2900
Mailing Address - Country:US
Mailing Address - Phone:713-790-1349
Mailing Address - Fax:713-790-0028
Practice Address - Street 1:7900 FANNIN ST
Practice Address - Street 2:SUITE 2300
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2900
Practice Address - Country:US
Practice Address - Phone:713-790-1349
Practice Address - Fax:713-790-0028
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ7130207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K5456OtherBLUE CROSS BLUE SHIELD
TX8A9909Medicare PIN