Provider Demographics
NPI:1518997477
Name:CLEMMONS, JOHN BENJAMIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BENJAMIN
Last Name:CLEMMONS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 HERMANN DR STE 220
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7009
Mailing Address - Country:US
Mailing Address - Phone:713-528-6562
Mailing Address - Fax:713-528-1045
Practice Address - Street 1:1213 HERMANN DR STE 220
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7009
Practice Address - Country:US
Practice Address - Phone:713-528-6562
Practice Address - Fax:713-528-1045
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG0677207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035370801Medicaid
TX00PN43Medicare ID - Type Unspecified
TX035370801Medicaid