Provider Demographics
NPI:1851397038
Name:MCCLELLAND, BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:MCCLELLAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:G.
Other - Middle Name:BRUCE
Other - Last Name:MCCLELLAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1424 N. MCDONALD ROAD
Mailing Address - Street 2:STE 101
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1088
Mailing Address - Country:US
Mailing Address - Phone:509-928-7272
Mailing Address - Fax:509-928-7346
Practice Address - Street 1:1424 N. MCDONALD ROAD
Practice Address - Street 2:STE 101
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1088
Practice Address - Country:US
Practice Address - Phone:509-928-7272
Practice Address - Fax:509-928-7346
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00012847207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8928428OtherCRIME VICTIMS
WA1553601Medicaid
WA14346OtherLABOR & INDUSTRIES
WA8928428OtherCRIME VICTIMS
WAA07735Medicare UPIN
WA040004185Medicare ID - Type UnspecifiedRAILROAD MEDICARE