Provider Demographics
NPI:1780674572
Name:MCCLAIN, DAVID ANDREW (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ANDREW
Last Name:MCCLAIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 E LAKE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKWELL CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50579-1711
Mailing Address - Country:US
Mailing Address - Phone:712-297-8989
Mailing Address - Fax:
Practice Address - Street 1:505 E LAKE ST
Practice Address - Street 2:
Practice Address - City:ROCKWELL CITY
Practice Address - State:IA
Practice Address - Zip Code:50579-1711
Practice Address - Country:US
Practice Address - Phone:712-297-8989
Practice Address - Fax:712-297-8991
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000615363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA41819Medicare ID - Type Unspecified
IAR81021Medicare UPIN