Provider Demographics
NPI:1346334430
Name:MCLAIN, PHIL C III (MD)
Entity Type:Individual
Prefix:
First Name:PHIL
Middle Name:C
Last Name:MCLAIN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:PHIL
Other - Middle Name:C
Other - Last Name:MCLAIN
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:110 13TH ST
Mailing Address - Street 2:
Mailing Address - City:HAVRE
Mailing Address - State:MT
Mailing Address - Zip Code:59501-5223
Mailing Address - Country:US
Mailing Address - Phone:406-265-4541
Mailing Address - Fax:406-265-2148
Practice Address - Street 1:110 13TH ST
Practice Address - Street 2:
Practice Address - City:HAVRE
Practice Address - State:MT
Practice Address - Zip Code:59501-5223
Practice Address - Country:US
Practice Address - Phone:406-265-4541
Practice Address - Fax:406-265-2148
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24726207Q00000X
MT11230207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0038961Medicaid
MTEO5679Medicare UPIN
MT0038961Medicaid