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NPI Code Detail

MEDICARE: ROBBIE MCCLATCHEY P.A.

MEDICARE: ROBBIE MCCLATCHEY P.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA624OK

General Provider Information

NPI Number : 1265469092
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBBIE MCCLATCHEY P.A.
Provider Business Mailing Address
First Line : 6190 WAGON WHEEL CIR
Second Line :
City : EL RENO
State : OK
Zip : 73036-8126
Country : US
Telephone Number : 405-376-9315
Fax Number : 405-634-7577
Provider Business Practice Location Address
First Line : 4525 S KLEIN AVE STE 1000
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73109-3839
Country : US
Telephone Number : 405-604-9595
Fax Number : 405-634-7577
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2006
Last Update Date : 12/31/2007

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