Healthcare Provider Details

I. General information

NPI: 1750538187
Provider Name (Legal Business Name): D M MCCLELLAN MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2008
Last Update Date: 01/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5214 S MAIN ST
CROSBY TX
77532-5825
US

IV. Provider business mailing address

P O BOX 1969
CROSBY TX
77532-7969
US

V. Phone/Fax

Practice location:
  • Phone: 281-328-4888
  • Fax: 281-328-8345
Mailing address:
  • Phone: 281-328-4888
  • Fax: 281-328-8345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG0476
License Number StateTX

VIII. Authorized Official

Name: DR. DAVID MARK MCCLELLAN
Title or Position: MEDICAL DOCTOR
Credential: MD
Phone: 281-328-4888