MEDICARE: DR. ANDREW CHARLES CLEMMONS D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	H4238	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	020041472	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	84251S	OTHER	TX	BLUECROSS BLUESHIELD
4	4331024	OTHER	TX	AETNA

General Provider Information

NPI Number	:	1013951763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW CHARLES CLEMMONS D.O.

Provider Business Mailing Address
First Line	:	2700 CITIZENS PLZ STE 403
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77901-5757
Country	:	US
Telephone Number	:	361-575-6396
Fax Number	:	361-578-5203

Provider Business Practice Location Address
First Line	:	2700 CITIZENS PLZ STE 403
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77901-5757
Country	:	US
Telephone Number	:	361-575-6396
Fax Number	:	361-578-5203

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	11/27/2023

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