Provider Demographics
NPI:1376587477
Name:MCLENDON, WILLIAM B (MD)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:B
Last Name:MCLENDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2469
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-2469
Mailing Address - Country:US
Mailing Address - Phone:800-945-2455
Mailing Address - Fax:
Practice Address - Street 1:1323 S 27TH ST
Practice Address - Street 2:SUITE 700
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-6294
Practice Address - Country:US
Practice Address - Phone:409-729-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14216174400000X
TXH00832085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3080304Medicaid
TX124755305Medicaid
TX124755305Medicaid
TN3080304Medicaid
TX421735ZP0TMedicare UPIN