MEDICARE: ROUSSEL CLEMENT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	L5284	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710977913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROUSSEL CLEMENT MD

Provider Business Mailing Address
First Line	:	6265 39TH ST
Second Line	:
City	:	GROVES
State	:	TX
Zip	:	77619-4614
Country	:	US
Telephone Number	:	409-962-4400
Fax Number	:	409-962-4412

Provider Business Practice Location Address
First Line	:	6265 39TH ST
Second Line	:
City	:	GROVES
State	:	TX
Zip	:	77619-4614
Country	:	US
Telephone Number	:	409-962-4400
Fax Number	:	409-962-4412

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	11/29/2023

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Directions to “ ROUSSEL CLEMENT MD” Practice Location

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