Provider Demographics
NPI:1851420616
Name:CLEAR LAKE UROLOGY
Entity Type:Organization
Organization Name:CLEAR LAKE UROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:HUMPHRIES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-316-3659
Mailing Address - Street 1:350 N TEXAS AVE
Mailing Address - Street 2:SUITE A2
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4959
Mailing Address - Country:US
Mailing Address - Phone:281-316-3659
Mailing Address - Fax:281-335-4529
Practice Address - Street 1:350 N TEXAS AVE
Practice Address - Street 2:SUITE A2
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4959
Practice Address - Country:US
Practice Address - Phone:281-316-3659
Practice Address - Fax:281-335-4529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1269208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF26645Medicare UPIN
TX00J44DMedicare PIN