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General NPI Number Information
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NPI Number | 1508124579
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Entity Type | Organization
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Legal Business Name | ROGER L. MCCLELLAN, MD, INC.
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Dates
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Enumeration Date | 04/27/2012
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 6311 TURNBERRY CIR
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648-5584
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Country | US
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Telephone | 714-960-7977
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Fax | 714-960-8534
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Provider Business Mailing Address
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Address Line | 6311 TURNBERRY CIR
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648-5584
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Country | US
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Telephone | 714-960-7977
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Fax | 714-960-8534
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROGER LEWIS MCCLELLAN
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Credential | MD
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Telephone | 714-960-7977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | A25690
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License Number State | CA
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