Healthcare Provider Details

I. General information

NPI: 1003669979
Provider Name (Legal Business Name): WILLIAM D MCCLELLAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2024
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18511 HIGHLANDER MEDICS ST
FORT BLISS TX
79906-5327
US

IV. Provider business mailing address

18511 HIGHLANDER MEDICS ST
FORT BLISS TX
79906-5327
US

V. Phone/Fax

Practice location:
  • Phone: 915-742-0576
  • Fax:
Mailing address:
  • Phone: 915-742-0576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberDR.0076359
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: