Provider Demographics
NPI:1467954081
Name:CLOPHUS, CECIL LAMONT
Entity Type:Individual
Prefix:MR
First Name:CECIL
Middle Name:LAMONT
Last Name:CLOPHUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7266 BURNS LN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-6540
Mailing Address - Country:US
Mailing Address - Phone:210-827-3907
Mailing Address - Fax:
Practice Address - Street 1:7266 BURNS LN
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250-6540
Practice Address - Country:US
Practice Address - Phone:210-827-3907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-28
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX149985164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse