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NPI Code Detail

MEDICARE: CLARENCE H PRIHODA JR. MD

MEDICARE: CLARENCE H PRIHODA JR. MD
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
1207Q00000XFamily Medicine PhysicianG4684TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1G4684OTHERTXPHYSICIAN PERMIT

General Provider Information

NPI Number : 1144212044
Entity Type Code : Individual
Provider Name (Legal Business Name) : CLARENCE H PRIHODA JR. MD
Provider Business Mailing Address
First Line : 501 E WASHINGTON AVE
Second Line :
City : NAVASOTA
State : TX
Zip : 77868-3001
Country : US
Telephone Number : 936-825-6444
Fax Number : 936-825-3340
Provider Business Practice Location Address
First Line : 501 E WASHINGTON AVE
Second Line :
City : NAVASOTA
State : TX
Zip : 77868-3001
Country : US
Telephone Number : 936-825-6444
Fax Number : 936-825-3340
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2005
Last Update Date : 01/31/2008

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