Provider Demographics
NPI:1598014458
Name:IVAN D. MCLAWS, DPM
Entity Type:Organization
Organization Name:IVAN D. MCLAWS, DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCLAWS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:928-474-9242
Mailing Address - Street 1:PO BOX 603
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85547
Mailing Address - Country:US
Mailing Address - Phone:928-474-9242
Mailing Address - Fax:928-474-9241
Practice Address - Street 1:200 EAST LONE PINE DR.
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541
Practice Address - Country:US
Practice Address - Phone:928-474-9242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0252213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty