Provider Demographics
NPI:1568467579
Name:DAVID T. NEMOTO M.D, P.A.
Entity Type:Organization
Organization Name:DAVID T. NEMOTO M.D, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:T
Authorized Official - Last Name:NEMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-467-2700
Mailing Address - Street 1:1446 CAMPBELL RD STE 200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-4604
Mailing Address - Country:US
Mailing Address - Phone:713-467-2700
Mailing Address - Fax:713-467-3308
Practice Address - Street 1:1446 CAMPBELL RD STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-4604
Practice Address - Country:US
Practice Address - Phone:713-467-2700
Practice Address - Fax:713-467-3308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9239174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1274367-04Medicaid
TX1274367-04Medicaid
TX00108XMedicare ID - Type UnspecifiedGROUP NUMBER