Provider Demographics
NPI:1871752949
Name:CLEMENT, CECILIA GLADYS (MD)
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:GLADYS
Last Name:CLEMENT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CECILIA
Other - Middle Name:G
Other - Last Name:MORON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 650859, DEPT. 710
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0859
Mailing Address - Country:US
Mailing Address - Phone:409-772-2222
Mailing Address - Fax:
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0548
Practice Address - Country:US
Practice Address - Phone:409-772-1011
Practice Address - Fax:409-772-2500
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP2972207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology