Organization
CLEVELAND CLINIC CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES FULNER (OFFICER/DIRECTOR)
(502) 777-8128
Entity
Organization
Contact information
Practice address
300 E CROCKETT ST, CLEVELAND, TX 77327-4029
(281) 592-3344
(281) 593-0952
Mailing address
300 E CROCKETT ST, CLEVELAND, TX 77327-4029
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208600000X
Surgery Physician
—
—
208800000X
Urology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
TX
Enumeration date
01/09/2012
Last updated
01/09/2012
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