Healthcare Provider Details

I. General information

NPI: 1558771303
Provider Name (Legal Business Name): CLFP MHT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2014
Last Update Date: 11/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14903 EL CAMINO REAL
HOUSTON TX
77062-2603
US

IV. Provider business mailing address

1515 HERITAGE DRIVE SUITE 110
MCKINNEY TX
75069-3379
US

V. Phone/Fax

Practice location:
  • Phone: 855-860-2109
  • Fax:
Mailing address:
  • Phone: 972-616-4702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH4622
License Number StateTX

VIII. Authorized Official

Name: JOE POUZAR
Title or Position: OWNER/ PRESIDENT
Credential: MD
Phone: 281-486-7900