Provider Demographics
NPI:1851329767
Name:MCCLAIN, DAVID CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CHARLES
Last Name:MCCLAIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:19021 US HIGHWAY 285
Mailing Address - Street 2:
Mailing Address - City:LA JARA
Mailing Address - State:CO
Mailing Address - Zip Code:81140-9410
Mailing Address - Country:US
Mailing Address - Phone:719-587-1417
Mailing Address - Fax:719-274-6003
Practice Address - Street 1:930 SW ABBEY ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-4820
Practice Address - Country:US
Practice Address - Phone:541-574-1818
Practice Address - Fax:541-574-1831
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2017-04-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT2761511205207Q00000X
ORMD175381207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTG01359Medicare UPIN