Provider Demographics
NPI:1083955090
Name:MCLEAN, DANIEL MAX (MPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:MAX
Last Name:MCLEAN
Suffix:
Gender:M
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8507 S 5TH ST STE 113
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98642-3422
Mailing Address - Country:US
Mailing Address - Phone:360-887-9494
Mailing Address - Fax:
Practice Address - Street 1:8507 S 5TH ST STE 113
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:WA
Practice Address - Zip Code:98642-3422
Practice Address - Country:US
Practice Address - Phone:360-887-9494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-15
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKPAD T 2368363A00000X
AK1211363AM0700X
390200000X
WAPA.PA.61311294363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program