Provider Demographics
NPI:1285864884
Name:CLEWING, JOHANNA MARIETTA (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHANNA
Middle Name:MARIETTA
Last Name:CLEWING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 FANNIN ST
Mailing Address - Street 2:THE METHODIST, DPT OF MEDICINE, SMITH TOWER SUITE 1001
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2717
Mailing Address - Country:US
Mailing Address - Phone:713-441-6722
Mailing Address - Fax:
Practice Address - Street 1:6550 FANNIN ST
Practice Address - Street 2:THE METHODIST, DPT OF MEDICINE, SMITH TOWER SUITE 1001
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2717
Practice Address - Country:US
Practice Address - Phone:713-441-6722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-17
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3568208M00000X
TXTEMPORARY LICENSE208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CC983OtherBCBS
TX1285864884OtherBLUE CROSS BLUE SHIELD
TXP00765636OtherRR MEDICARE
TX205622801Medicaid
TX2056222803Medicaid
TX205622802Medicaid
TXP00765636OtherMEDICARE RAILROAD
TXP00896806OtherMEDICARE RR
TX1285864884OtherBLUE CROSS BLUE SHIELD
TXP00896806OtherMEDICARE RR
TX502130ZSWDMedicare PIN