Provider Demographics
NPI:1578032363
Name:ENDOCRINOLOGY CLINIC AT CLEAR LAKE SPECIALTIES PLLC
Entity Type:Organization
Organization Name:ENDOCRINOLOGY CLINIC AT CLEAR LAKE SPECIALTIES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BABA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-724-8333
Mailing Address - Street 1:PO BOX 57336
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-7336
Mailing Address - Country:US
Mailing Address - Phone:281-724-8333
Mailing Address - Fax:281-724-1861
Practice Address - Street 1:600 N KOBAYASHI STE 312
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4841
Practice Address - Country:US
Practice Address - Phone:281-724-8333
Practice Address - Fax:281-724-1861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-21
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty