Provider Demographics
NPI:1639170962
Name:MCCLELLAND, JOHN SPENCE (M D)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:SPENCE
Last Name:MCCLELLAND
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 HENNESSY BLVD
Mailing Address - Street 2:SUTIE 1000
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4300
Mailing Address - Country:US
Mailing Address - Phone:225-767-3900
Mailing Address - Fax:225-214-9109
Practice Address - Street 1:7777 HENNESSY BLVD
Practice Address - Street 2:SUTIE 1000
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4300
Practice Address - Country:US
Practice Address - Phone:225-767-3900
Practice Address - Fax:225-214-9109
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05977R207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA060021708OtherPALMETTO GBA
LA232761OtherWELLCARE
LA2500227OtherUNITED HEALTHCARE
LA4211623OtherAETNA
LAB64474Medicare UPIN
LA232761OtherWELLCARE