Provider Demographics
NPI:1821484957
Name:MCLAM, BRITTNI (DO)
Entity Type:Individual
Prefix:
First Name:BRITTNI
Middle Name:
Last Name:MCLAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 IDAHO ST
Mailing Address - Street 2:
Mailing Address - City:GOODING
Mailing Address - State:ID
Mailing Address - Zip Code:83330-1258
Mailing Address - Country:US
Mailing Address - Phone:208-934-5900
Mailing Address - Fax:
Practice Address - Street 1:425 IDAHO ST
Practice Address - Street 2:
Practice Address - City:GOODING
Practice Address - State:ID
Practice Address - Zip Code:83330-1258
Practice Address - Country:US
Practice Address - Phone:208-934-5900
Practice Address - Fax:208-934-5719
Is Sole Proprietor?:No
Enumeration Date:2015-04-15
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN60824207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine