Healthcare Provider Details

I. General information

NPI: 1144212044
Provider Name (Legal Business Name): CLARENCE H PRIHODA JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 E WASHINGTON AVE
NAVASOTA TX
77868-3001
US

IV. Provider business mailing address

501 E WASHINGTON AVE
NAVASOTA TX
77868-3001
US

V. Phone/Fax

Practice location:
  • Phone: 936-825-6444
  • Fax: 936-825-3340
Mailing address:
  • Phone: 936-825-6444
  • Fax: 936-825-3340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG4684
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: