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General NPI Number Information
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NPI Number | 1356508212
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Entity Type | Organization
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Legal Business Name | CLIFFORD O. MISHAW, M.D., P.C.
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Dates
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Enumeration Date | 05/19/2008
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Last Update Date | 05/19/2008
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Provider Practice Location Address
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Address Line | 6410 FANNIN ST STE 410
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City | HOUSTON
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State | TX
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Zip | 77030-3005
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Country | US
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Telephone | 713-796-8300
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Fax |
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Provider Business Mailing Address
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Address Line | 6410 FANNIN ST STE 410
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City | HOUSTON
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State | TX
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Zip | 77030-3005
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Country | US
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Telephone | 713-796-8300
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CLIFFORD OWEN MISHAW
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Credential | M.D.
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Telephone | 713-796-8300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | F4293
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License Number State | TX
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