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Organization
GOLDEN CRESCENT MEDICAL CLINIC
Active
Organization
GOLDEN CRESCENT MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROUCHDY SHENOUDA M.D. (OWNER)
(361) 576-3680
Entity
Organization
Contact information
Practice address
3402 CHERRY ST, VICTORIA, TX 77901-0921
(361) 579-6900
Mailing address
3402 CHERRY ST, VICTORIA, TX 77901-0921
(361) 579-6900
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E9406
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00938T
BCBS OF TX #
TX
05
—
153561901
—
TX
Enumeration date
12/16/2005
Last updated
06/30/2009
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