Provider Demographics
NPI:1720147762
Name:ROUSSEL CLEMENT MDPA
Entity Type:Organization
Organization Name:ROUSSEL CLEMENT MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROUSSEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMENT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-626-2169
Mailing Address - Street 1:6265 39TH ST
Mailing Address - Street 2:
Mailing Address - City:GROVES
Mailing Address - State:TX
Mailing Address - Zip Code:77619-4614
Mailing Address - Country:US
Mailing Address - Phone:409-962-4400
Mailing Address - Fax:409-962-4412
Practice Address - Street 1:6265 39TH ST
Practice Address - Street 2:
Practice Address - City:GROVES
Practice Address - State:TX
Practice Address - Zip Code:77619-4614
Practice Address - Country:US
Practice Address - Phone:409-962-4400
Practice Address - Fax:409-962-4412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty