Provider Demographics
NPI:1417028036
Name:MCLEAN, DOROTHY E (DPM)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:E
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:DPM
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 27195
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-7195
Mailing Address - Country:US
Mailing Address - Phone:559-970-3749
Mailing Address - Fax:559-438-9201
Practice Address - Street 1:6335 N FRESNO ST STE 102
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5272
Practice Address - Country:US
Practice Address - Phone:559-438-0283
Practice Address - Fax:559-438-9201
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3876213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE3876OtherCA LICENSE #
CAE3876OtherCA LICENSE #
CA000E38760Medicare PIN