Healthcare Provider Details

I. General information

NPI: 1437543626
Provider Name (Legal Business Name): CLEAR LAKE ONCOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2015
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N KOBAYASHI STE 310
WEBSTER TX
77598
US

IV. Provider business mailing address

PO BOX 58778
WEBSTER TX
77598-8778
US

V. Phone/Fax

Practice location:
  • Phone: 281-724-8335
  • Fax: 281-724-1861
Mailing address:
  • Phone: 281-724-8335
  • Fax: 281-724-1861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: JEANNE FRAZIER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 281-724-7145