Provider Demographics
NPI:1780167296
Name:CLEAR CHOICE PHYSICIAN GROUP
Entity type:Organization
Organization Name:CLEAR CHOICE PHYSICIAN GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTANADA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:956-206-5980
Mailing Address - Street 1:7105 N. BARTLETT AVE.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6466
Mailing Address - Country:US
Mailing Address - Phone:956-206-5980
Mailing Address - Fax:281-466-1140
Practice Address - Street 1:7105 N BARTLETT AVE STE 101
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6466
Practice Address - Country:US
Practice Address - Phone:281-363-3156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-11
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty