Provider Demographics
NPI:1629967864
Name:CLENDENIN MD LLC
Entity type:Organization
Organization Name:CLENDENIN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:KEELE
Authorized Official - Last Name:CLENDENIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-220-5000
Mailing Address - Street 1:2028 E BEN WHITE BLVD STE 240-7980
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-6966
Mailing Address - Country:US
Mailing Address - Phone:737-333-2400
Mailing Address - Fax:405-622-4004
Practice Address - Street 1:1081 N BRYANT AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-3208
Practice Address - Country:US
Practice Address - Phone:737-333-2400
Practice Address - Fax:405-785-3622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty