Provider Demographics
NPI:1881654960
Name:MCCLINTOCK, JOSEPH MILTON (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MILTON
Last Name:MCCLINTOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6250 REGIONAL PLZ
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-5262
Mailing Address - Country:US
Mailing Address - Phone:325-428-5520
Mailing Address - Fax:325-428-5525
Practice Address - Street 1:6250 REGIONAL PLZ
Practice Address - Street 2:SUITE 1010
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5262
Practice Address - Country:US
Practice Address - Phone:325-428-5500
Practice Address - Fax:325-428-5519
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19343208800000X
TXH8245208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100222120BMedicaid
OK100222120BMedicaid
F02305Medicare UPIN