Provider Demographics
NPI:1790029007
Name:JOHN M MCLEAN
Entity Type:Organization
Organization Name:JOHN M MCLEAN
Other - Org Name:MCLEAN MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:MCLEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-819-1707
Mailing Address - Street 1:3700 MCDONALD RD
Mailing Address - Street 2:APT 260
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-6253
Mailing Address - Country:US
Mailing Address - Phone:734-819-1707
Mailing Address - Fax:
Practice Address - Street 1:3700 MCDONALD RD
Practice Address - Street 2:APT 260
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-6253
Practice Address - Country:US
Practice Address - Phone:734-819-1707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty