Provider Demographics
NPI:1528193638
Name:MCLEAN, PIERSON SCOTT JR (MD)
Entity Type:Individual
Prefix:DR
First Name:PIERSON
Middle Name:SCOTT
Last Name:MCLEAN
Suffix:JR
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 2198
Mailing Address - Street 2:
Mailing Address - City:KETCHUM
Mailing Address - State:ID
Mailing Address - Zip Code:83340-2198
Mailing Address - Country:US
Mailing Address - Phone:208-726-9361
Mailing Address - Fax:
Practice Address - Street 1:333 S. MAIN ST.
Practice Address - Street 2:SUITE 108
Practice Address - City:KETCHUM
Practice Address - State:ID
Practice Address - Zip Code:83340
Practice Address - Country:US
Practice Address - Phone:208-726-9361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-5300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDA 36646Medicare UPIN