1437349537 NPI number — CURTIS P. CLOGSTON, MD, JD, PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437349537 NPI number — CURTIS P. CLOGSTON, MD, JD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CURTIS P. CLOGSTON, MD, JD, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CORRIDOR MEDICAL CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437349537
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1348 HIGHWAY 123
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
SAN MARCOS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78666-7836
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-392-5556
Provider Business Mailing Address Fax Number:
512-392-8828

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1348 HIGHWAY 123
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SAN MARCOS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78666-7836
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-392-5556
Provider Business Practice Location Address Fax Number:
512-392-8828
Provider Enumeration Date:
07/26/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CLOGSTON
Authorized Official First Name:
CURTIS
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
512-392-5556

Provider Taxonomy Codes

  • Taxonomy code: 2083X0100X , with the licence number:  MDF1457TX , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: PT1140044TX , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 660250 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)