MEDICARE: MARTIN BARRY MCCLINTOCK MD

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
1	207Q00000X	Family Medicine Physician	R7737	MO

General Provider Information

NPI Number	:	1427046366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTIN BARRY MCCLINTOCK MD

Provider Business Mailing Address
First Line	:	15421 CLAYTON RD
Second Line	:	SUITE G-2
City	:	BALLWIN
State	:	MO
Zip	:	63011-3161
Country	:	US
Telephone Number	:	636-227-2707
Fax Number	:	636-227-1216

Provider Business Practice Location Address
First Line	:	15421 CLAYTON RD
Second Line	:	SUITE G-2
City	:	BALLWIN
State	:	MO
Zip	:	63011-3161
Country	:	US
Telephone Number	:	636-227-2707
Fax Number	:	636-227-1216

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	05/01/2012

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