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Individual

MICHAEL NEILL CLEMENSHAW

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
3551 ROGER BROOKE DR, FORT SAM HOUSTON, TX 78234-4504
(210) 916-4188
Mailing address
3551 ROGER BROOKE DR, FORT SAM HOUSTON, TX 78234-4504
(210) 539-9582

Taxonomy

Speciality
Code
Description
License number
State
207UN0902X
Nuclear Imaging & Therapy Physician
P2216
TX
2085R0202X
Diagnostic Radiology Physician
Primary
P2216
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
003226229A
GA
01
83825
GEORGIA MEDICAL LICENSE
GA
Enumeration date
04/27/2007
Last updated
10/03/2023
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