Provider Demographics
NPI:1144481045
Name:ALLIED PHYSICIANS GROUP PLLC
Entity type:Organization
Organization Name:ALLIED PHYSICIANS GROUP PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROUSSEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMENT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-984-7640
Mailing Address - Street 1:5502 39TH ST
Mailing Address - Street 2:SUITE #102
Mailing Address - City:GROVES
Mailing Address - State:TX
Mailing Address - Zip Code:77619-2929
Mailing Address - Country:US
Mailing Address - Phone:409-984-7640
Mailing Address - Fax:409-984-7641
Practice Address - Street 1:5502 39TH ST
Practice Address - Street 2:SUITE #102
Practice Address - City:GROVES
Practice Address - State:TX
Practice Address - Zip Code:77619-2929
Practice Address - Country:US
Practice Address - Phone:409-984-7640
Practice Address - Fax:409-984-7641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty