Healthcare Provider Details

I. General information

NPI: 1700095338
Provider Name (Legal Business Name): DARRYL WILLIAM DEAN MCCLINTOCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 04/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2655 ENTERPRISE RD
RENO NV
89512-1666
US

IV. Provider business mailing address

2655 ENTERPRISE RD
RENO NV
89512-1666
US

V. Phone/Fax

Practice location:
  • Phone: 267-258-3857
  • Fax:
Mailing address:
  • Phone: 267-258-3857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMDR- 4823
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number12755
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: