Healthcare Provider Details

I. General information

NPI: 1245678556
Provider Name (Legal Business Name): JOHN ELLIOTT MCLEAN III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2013
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18951 N MEMORIAL DR
HUMBLE TX
77338
US

IV. Provider business mailing address

8917 SUNGATE DR
PEARLAND TX
77584-3200
US

V. Phone/Fax

Practice location:
  • Phone: 281-540-7700
  • Fax:
Mailing address:
  • Phone: 832-459-2823
  • Fax: 832-459-2823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR2671
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: