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General NPI Number Information
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NPI Number | 1639350374
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Entity Type | Organization
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Legal Business Name | ELLIOTT I CLEMENCE MDPA
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Dates
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Enumeration Date | 11/23/2007
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Last Update Date | 01/12/2010
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Provider Practice Location Address
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Address Line | 7500 BARLITE BLVD STE 309
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City | SAN ANTONIO
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State | TX
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Zip | 78224-1363
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Country | US
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Telephone | 210-924-9000
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Fax | 210-924-7300
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Provider Business Mailing Address
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Address Line | 7500 BARLITE BLVD STE 309
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City | SAN ANTONIO
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State | TX
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Zip | 78224-1363
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Country | US
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Telephone | 210-924-9000
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Fax | 210-924-7300
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ELLIOTT IRVING CLEMENCE III
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Credential | M.D.
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Telephone | 210-924-9000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | K0004
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License Number State | TX
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