Provider Demographics
NPI:1629267752
Name:CLEAR LAKE ENT, P.A
Entity Type:Organization
Organization Name:CLEAR LAKE ENT, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-335-7755
Mailing Address - Street 1:PO BOX 580451
Mailing Address - Street 2:LOCK BOX 157102
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77258-0451
Mailing Address - Country:US
Mailing Address - Phone:281-335-7755
Mailing Address - Fax:281-335-7766
Practice Address - Street 1:18100 SAINT JOHN DR
Practice Address - Street 2:SUITE 240
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3631
Practice Address - Country:US
Practice Address - Phone:281-335-7755
Practice Address - Fax:281-335-7766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4653174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K6340OtherBCBS
TX0029KVOtherMCARE
TXF68110OtherUPIN
TX10023864OtherAMERIGROUP
TXF68110OtherUPIN
TX8B3757Medicare PIN