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General NPI Number Information
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NPI Number | 1902019649
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Entity Type | Organization
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Legal Business Name | MCLEAN ORTHOPAEDICS PA
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 07/22/2010
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Provider Practice Location Address
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Address Line | 1300 N MOUND ST
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City | NACOGDOCHES
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State | TX
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Zip | 75961-4029
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Country | US
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Telephone | 936-560-2990
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 632749
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City | NACOGDOCHES
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State | TX
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Zip | 75963-2749
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Country | US
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Telephone | 936-560-2990
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL ROY MCLEAN
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Credential | MD
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Telephone | 936-560-2990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | E2718
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License Number State | TX
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