MEDICARE: CLIVE K FIELDS M.D.

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	207Q00000X	Family Medicine Physician	H6216	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8433K0	OTHER	TX	MEDICARE ID #

General Provider Information

NPI Number	:	1366447583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLIVE K FIELDS M.D.

Provider Business Mailing Address
First Line	:	9055 KATY FWY
Second Line	:	STE 200
City	:	HOUSTON
State	:	TX
Zip	:	77024-1629
Country	:	US
Telephone Number	:	713-461-2915
Fax Number	:	713-461-5307

Provider Business Practice Location Address
First Line	:	9055 KATY FWY
Second Line	:	STE 200
City	:	HOUSTON
State	:	TX
Zip	:	77024-1624
Country	:	US
Telephone Number	:	713-461-2915
Fax Number	:	713-461-5307

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

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	01/14/2019

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Directions to “ CLIVE K FIELDS M.D.” Practice Location

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