Healthcare Provider Details

I. General information

NPI: 1861743247
Provider Name (Legal Business Name): CLEAR LAKE PRIMARY CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2012
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 W MEDICAL CENTER BLVD STE 405
WEBSTER TX
77598-4009
US

IV. Provider business mailing address

PO BOX 57845
WEBSTER TX
77598-7845
US

V. Phone/Fax

Practice location:
  • Phone: 281-724-1862
  • Fax: 281-724-1859
Mailing address:
  • Phone: 281-724-1862
  • Fax: 281-724-1859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberN6807
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM9397
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberL2542
License Number StateTX
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MOHAMMAD J BABA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 281-724-1860