Provider Demographics
NPI:1114920592
Name:MCCLELLAN, JOHN WILLIAM III (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILLIAM
Last Name:MCCLELLAN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:13616 CALIFORNIA ST
Mailing Address - Street 2:STE 100
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-5335
Mailing Address - Country:US
Mailing Address - Phone:402-496-0404
Mailing Address - Fax:402-496-0517
Practice Address - Street 1:13616 CALIFORNIA ST
Practice Address - Street 2:STE 100
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-5335
Practice Address - Country:US
Practice Address - Phone:402-496-0404
Practice Address - Fax:402-496-0517
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19730207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE00094OtherBCBS
NE200037481OtherRAILROAD MEDICARE
NE1514281Medicaid
NE47081304012Medicaid
NE272365Medicare PIN
NEG04151Medicare UPIN