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General NPI Number Information
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NPI Number | 1154945111
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Entity Type | Organization
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Legal Business Name | GASTROENTEROLOGY OF TEXAS, PLLC
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Dates
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Enumeration Date | 06/04/2020
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Last Update Date | 10/02/2020
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Provider Practice Location Address
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Address Line | 2510 S LOOP 336 W STE 336
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City | CONROE
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State | TX
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Zip | 77304
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Country | US
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Telephone | 713-955-2889
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Fax | 254-780-0332
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Provider Business Mailing Address
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Address Line | 6606 FM 1488 RD STE 148-368
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City | MAGNOLIA
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State | TX
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Zip | 77354-2544
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | DR. MATTHEW TIMOTHY CLARK
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Credential | MD
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Telephone | 832-510-5711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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