Provider Demographics
NPI:1396863908
Name:JAIME CLAVIJO MD PA
Entity type:Organization
Organization Name:JAIME CLAVIJO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLAVIJO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-432-9614
Mailing Address - Street 1:PO BOX 2287
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77402-2287
Mailing Address - Country:US
Mailing Address - Phone:713-432-9614
Mailing Address - Fax:713-776-1101
Practice Address - Street 1:7737 SOUTHWEST FWY
Practice Address - Street 2:SUITE 565
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1807
Practice Address - Country:US
Practice Address - Phone:713-432-9614
Practice Address - Fax:713-776-1101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2191207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00834TMedicare PIN
TXH57401Medicare UPIN