Individual
DR. CLINTON D. POLHAMUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1804 NE LOOP 410, #101, SAN ANTONIO, TX 78217-5211
(210) 828-8400
(210) 804-4454
Mailing address
1804 NE LOOP 410, #101, SAN ANTONIO, TX 78217-5211
(210) 828-8400
(210) 804-4454
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
E8822
TX
207RG0100X
Gastroenterology Physician
Primary
G2539
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114369504
—
TX
Enumeration date
09/01/2005
Last updated
09/14/2010
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