Healthcare Provider Details

I. General information

NPI: 1982921854
Provider Name (Legal Business Name): MATTHEW D. MCLAREN, MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2010
Last Update Date: 04/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1744 ALDER DR
GREAT FALLS MT
59404-3533
US

IV. Provider business mailing address

1744 ALDER DR
GREAT FALLS MT
59404-3533
US

V. Phone/Fax

Practice location:
  • Phone: 406-952-0420
  • Fax:
Mailing address:
  • Phone: 406-952-0420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number11260
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number200400236
License Number StateNC

VIII. Authorized Official

Name: DR. MATTHEW D MCLAREN
Title or Position: PRESIDENT
Credential: MD
Phone: 406-952-0420