Provider Demographics
NPI:1487657896
Name:MCCLAIN, DEBRA R (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:R
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 N IRONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46615-2520
Mailing Address - Country:US
Mailing Address - Phone:574-968-1222
Mailing Address - Fax:574-968-1223
Practice Address - Street 1:310 N IRONWOOD DR
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46615-2520
Practice Address - Country:US
Practice Address - Phone:574-968-1222
Practice Address - Fax:574-968-1223
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01028643207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100091000AMedicaid
INEO5311Medicare UPIN
IN100091000AMedicaid