MEDICARE: TONY S. MCCLUNG MD PA

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1437305240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TONY S. MCCLUNG MD PA

Provider Business Mailing Address
First Line	:	1213 HERMANN DR STE 520
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-7011
Country	:	US
Telephone Number	:	713-528-3444
Fax Number	:	713-528-4434

Provider Business Practice Location Address
First Line	:	1213 HERMANN DR STE 520
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-7011
Country	:	US
Telephone Number	:	713-528-3444
Fax Number	:	713-528-4434

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	SCOTT TUCKER
Credential	:
Telephone Number	:	713-528-3444

Provider Enumeration Date	:	08/12/2008
Last Update Date	:	08/12/2008

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