Provider Demographics
NPI:1437349537
Name:CURTIS P. CLOGSTON, MD, JD, PA
Entity Type:Organization
Organization Name:CURTIS P. CLOGSTON, MD, JD, PA
Other - Org Name:CORRIDOR MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:P
Authorized Official - Last Name:CLOGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD, JD
Authorized Official - Phone:512-392-5556
Mailing Address - Street 1:1348 HIGHWAY 123
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7836
Mailing Address - Country:US
Mailing Address - Phone:512-392-5556
Mailing Address - Fax:512-392-8828
Practice Address - Street 1:1348 HIGHWAY 123
Practice Address - Street 2:SUITE A
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7836
Practice Address - Country:US
Practice Address - Phone:512-392-5556
Practice Address - Fax:512-392-8828
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CURTIS P. CLOGSTON, MD, JD, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-26
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMDF1457TX2083X0100X
TXPT1140044TX225100000X
TX660250363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB21905Medicare UPIN
TX8C0646Medicare PIN
TX00992WMedicare PIN