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General NPI Number Information
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NPI Number | 1750538187
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Entity Type | Organization
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Legal Business Name | D M MCCLELLAN MD PA
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Dates
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Enumeration Date | 08/27/2008
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Last Update Date | 01/14/2009
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Provider Practice Location Address
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Address Line | 5214 S MAIN ST
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City | CROSBY
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State | TX
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Zip | 77532-5825
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Country | US
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Telephone | 281-328-4888
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Fax | 281-328-8345
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Provider Business Mailing Address
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Address Line | P O BOX 1969
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City | CROSBY
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State | TX
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Zip | 77532-7969
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Country | US
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Telephone | 281-328-4888
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Fax | 281-328-8345
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | DR. DAVID MARK MCCLELLAN
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Credential | MD
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Telephone | 281-328-4888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G0476
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License Number State | TX
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