Healthcare Provider Details

I. General information

NPI: 1588658892
Provider Name (Legal Business Name): INTERNAL MEDICINE ASSOCIATES LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5502 39TH ST #105
GROVES TX
77619-2929
US

IV. Provider business mailing address

5502 39TH ST #105
GROVES TX
77619-2929
US

V. Phone/Fax

Practice location:
  • Phone: 409-962-7606
  • Fax: 409-962-6027
Mailing address:
  • Phone: 409-962-7606
  • Fax: 409-962-6027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ROUSSEL CLEMENT
Title or Position: 50 PARTNER OF LLP
Credential: MD
Phone: 409-962-7606