Provider Demographics
NPI:1811921059
Name:CLYBURN, TERRY A (MD,PA)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:A
Last Name:CLYBURN
Suffix:
Gender:M
Credentials:MD,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6445 MAIN ST
Mailing Address - Street 2:SUITE 2500
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1502
Mailing Address - Country:US
Mailing Address - Phone:713-441-9000
Mailing Address - Fax:713-790-2058
Practice Address - Street 1:6445 MAIN ST
Practice Address - Street 2:SUITE 2500
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1502
Practice Address - Country:US
Practice Address - Phone:713-441-9000
Practice Address - Fax:713-790-2058
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3846207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137857211Medicaid
TX81Z182OtherBCBS
TX200031823OtherRAILROAD MEDICARE
TX8FX450OtherBLUE CROSS BLUE SHIELD
TX137857202OtherCSHCN
TX137857219Medicaid
TX8FX450OtherBLUE CROSS BLUE SHIELD
TX459102ZSWDMedicare PIN
TX137857219Medicaid