Provider Demographics
NPI:1578610416
Name:MCCLANE, THOMAS K (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:K
Last Name:MCCLANE
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 1:107 MORNINGSIDE DR STE C
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-2600
Mailing Address - Country:US
Mailing Address - Phone:863-686-4247
Mailing Address - Fax:863-802-1818
Practice Address - Street 1:107 MORNINGSIDE DR STE C
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-2600
Practice Address - Country:US
Practice Address - Phone:863-686-4247
Practice Address - Fax:863-802-1818
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME11240173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine