Provider Demographics
NPI:1013951763
Name:CLEMMONS, ANDREW CHARLES (DO)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:CHARLES
Last Name:CLEMMONS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2700 CITIZENS PLZ STE 403
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5757
Mailing Address - Country:US
Mailing Address - Phone:361-575-6396
Mailing Address - Fax:361-578-5203
Practice Address - Street 1:2700 CITIZENS PLZ STE 403
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5757
Practice Address - Country:US
Practice Address - Phone:361-575-6396
Practice Address - Fax:361-578-5203
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH4238208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX020041472OtherRAILROAD MEDICARE
TX131501204Medicaid
TX84251SOtherBLUECROSS BLUESHIELD
TX4331024OtherAETNA