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Organization
STANDARD MEDICAL CLINIC, PA
Active
Organization
STANDARD MEDICAL CLINIC, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BOBBY MAYOR (COO ADMINISTRATOR)
(409) 293-9125
Entity
Organization
Contact information
Practice address
8333 9TH AVE.,, SUITE A, PORT ARTHUR, TX 77642-8151
(409) 727-2808
Mailing address
8333 9TH AVE STE A, PORT ARTHUR, TX 77642-8151
(409) 727-2808
(409) 727-5933
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00358Y
MEDICARE GROUP PTAN
TX
05
—
172115101
—
TX
01
—
8937M0
BCBS PROV NO.
TX
01
—
K0026
STATE LICENSE
TX
01
—
R1944
TEXAS LIC
TX
Enumeration date
01/09/2007
Last updated
07/09/2026
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