Organization
CLEAR LAKE ENT, P.A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALFREDO JIMENEZ M.D. (OWNER)
(281) 335-7755
Entity
Organization
Contact information
Practice address
18100 SAINT JOHN DR, SUITE 240, HOUSTON, TX 77058-3631
(281) 335-7755
(281) 335-7766
Mailing address
PO BOX 580451, LOCK BOX 157102, HOUSTON, TX 77258-0451
(281) 335-7755
(281) 335-7766
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
J4653
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0029KV
MCARE
TX
01
—
10023864
AMERIGROUP
TX
01
—
8K6340
BCBS
TX
01
—
F68110
UPIN
TX
Enumeration date
10/15/2007
Last updated
10/15/2007
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