=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841288362
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TONY S MCCLUNG MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2005
-----------------------------------------------------
Last Update Date | 12/07/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1213 HERMANN DR SUITE 520
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77004-7018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-528-3444
-----------------------------------------------------
Fax | 713-528-4434
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1213 HERMANN DR SUITE 520
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77004-7018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-528-3444
-----------------------------------------------------
Fax | 713-528-4434
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number | E6138
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------