Healthcare Provider Details

I. General information

NPI: 1710971122
Provider Name (Legal Business Name): HARVEY W. MCCLUNG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 10/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 E ORMAN AVE SUITE 254
PUEBLO CO
81004-3537
US

IV. Provider business mailing address

1 VINCA CT
PUEBLO CO
81008-1923
US

V. Phone/Fax

Practice location:
  • Phone: 719-564-1542
  • Fax: 719-566-0916
Mailing address:
  • Phone: 719-542-5319
  • Fax: 719-566-0916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number25242
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number25242
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: