Healthcare Provider Details

I. General information

NPI: 1053343962
Provider Name (Legal Business Name): WILLIAM M. MCLEAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 11/18/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 WILFORD HALL LOOP, JBSA LACKLAND AFB
SAN ANTONIO TX
78236
US

IV. Provider business mailing address

1307 LAKEWINDS CIR
NEW BRAUNFELS TX
78130-2982
US

V. Phone/Fax

Practice location:
  • Phone: 210-394-7462
  • Fax:
Mailing address:
  • Phone: 210-394-7462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberCONV
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA02674
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: