Provider Demographics
NPI:1760751788
Name:TONY S. MCCLUNG, M.D.,P.A.
Entity Type:Organization
Organization Name:TONY S. MCCLUNG, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:SPURGEON
Authorized Official - Last Name:MCCLUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-528-3444
Mailing Address - Street 1:1213 HERMANN DRIVE
Mailing Address - Street 2:SUITE 520
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7011
Mailing Address - Country:US
Mailing Address - Phone:713-528-3444
Mailing Address - Fax:713-528-4434
Practice Address - Street 1:1213 HERMANN DR
Practice Address - Street 2:SUITE 520
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7018
Practice Address - Country:US
Practice Address - Phone:713-528-3444
Practice Address - Fax:713-528-4434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6138208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000TA84Medicaid
TXP000TA84Medicaid