Provider Demographics
NPI:1437217494
Name:MCCLINTOCK, ROY ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:ALAN
Last Name:MCCLINTOCK
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 1:1100 E LAKE ST
Mailing Address - Street 2:SUITE 260
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-3343
Mailing Address - Country:US
Mailing Address - Phone:903-597-9400
Mailing Address - Fax:903-597-9401
Practice Address - Street 1:825 MEDICAL DR STE A
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2143
Practice Address - Country:US
Practice Address - Phone:903-758-2610
Practice Address - Fax:903-758-7081
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2195207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156047601Medicaid
TX00387UMedicare ID - Type UnspecifiedMEDICARE
TX156047601Medicaid