Provider Demographics
NPI:1174611578
Name:MCCLELLAND, JAMES Q (DPM)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:Q
Last Name:MCCLELLAND
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2002 12TH AVENUE NW
Mailing Address - Street 2:SUITE F
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401
Mailing Address - Country:US
Mailing Address - Phone:580-223-0718
Mailing Address - Fax:580-223-0719
Practice Address - Street 1:2002 12TH AVENUE NW
Practice Address - Street 2:SUITE F
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401
Practice Address - Country:US
Practice Address - Phone:580-223-0718
Practice Address - Fax:580-223-0719
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK111213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
730979578002OtherBCBS
480009536OtherRAILROAD
480009536OtherRAILROAD
T40765Medicare UPIN
243321107Medicare ID - Type Unspecified