Healthcare Provider Details

I. General information

NPI: 1649405754
Provider Name (Legal Business Name): MR. CLARENCE LEVI PIGGIE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2009
Last Update Date: 05/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7523 BRAEBERRY CT
RICHMOND TX
77407-2395
US

IV. Provider business mailing address

7523 BRAEBERRY CT
RICHMOND TX
77407-2395
US

V. Phone/Fax

Practice location:
  • Phone: 281-277-8730
  • Fax:
Mailing address:
  • Phone: 281-277-8730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: