MEDICARE: JEAN MCCLINTOCK M.D., F.A.C.O.G.

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	207V00000X	Obstetrics & Gynecology Physician	J6575	TX

General Provider Information

NPI Number	:	1619979507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN MCCLINTOCK M.D., F.A.C.O.G.

Provider Business Mailing Address
First Line	:	7777 FOREST LN
Second Line	:	C-234
City	:	DALLAS
State	:	TX
Zip	:	75230-2505
Country	:	US
Telephone Number	:	972-566-7711
Fax Number	:

Provider Business Practice Location Address
First Line	:	7777 FOREST LN
Second Line	:	C-234
City	:	DALLAS
State	:	TX
Zip	:	75230-2505
Country	:	US
Telephone Number	:	972-566-7711
Fax Number	:

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	10/23/2007

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