Provider Demographics
NPI:1104044460
Name:MCCLAM, COBY (FIT)
Entity Type:Individual
Prefix:MR
First Name:COBY
Middle Name:
Last Name:MCCLAM
Suffix:
Gender:M
Credentials:FIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8934 RESHARD LN
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-9073
Mailing Address - Country:US
Mailing Address - Phone:850-391-2536
Mailing Address - Fax:850-391-2533
Practice Address - Street 1:1989 CAPITAL CIR NE STE 9
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4476
Practice Address - Country:US
Practice Address - Phone:850-443-3175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist