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General NPI Number Information
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NPI Number | 1346511839
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Entity Type | Organization
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Legal Business Name | GARY M MCCLERNAN DPM PA
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Dates
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Enumeration Date | 01/16/2012
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Last Update Date | 05/25/2018
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Provider Practice Location Address
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Address Line | 14741 WATERWAY DR
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City | HUDSON
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State | FL
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Zip | 34667-3258
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Country | US
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Telephone | 727-432-1919
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Fax | 727-260-4170
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Provider Business Mailing Address
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Address Line | 14741 WATERWAY DR
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City | HUDSON
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State | FL
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Zip | 34667-3258
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Country | US
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Telephone | 727-432-1919
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Fax | 727-260-4170
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. GARY MARC MCCLERNAN
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Credential | D.P.M.
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Telephone | 727-432-1919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PO2389
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License Number State | FL
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