Provider Demographics
NPI:1427001528
Name:MCLEAN, ARCHIE H JR (DO)
Entity Type:Individual
Prefix:
First Name:ARCHIE
Middle Name:H
Last Name:MCLEAN
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 NW 49TH ST STE 125
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3750
Mailing Address - Country:US
Mailing Address - Phone:954-463-7313
Mailing Address - Fax:954-527-6082
Practice Address - Street 1:1111 W BROWARD BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-1638
Practice Address - Country:US
Practice Address - Phone:954-463-7313
Practice Address - Fax:954-527-6003
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5772207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL064171500Medicaid
FL80403UMedicare ID - Type Unspecified