Provider Demographics
NPI:1356533426
Name:MCCLARY, JOAN M (MD)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:M
Last Name:MCCLARY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 CHAPEL DR
Mailing Address - Street 2:
Mailing Address - City:MEXIA
Mailing Address - State:TX
Mailing Address - Zip Code:76667-3490
Mailing Address - Country:US
Mailing Address - Phone:254-562-2821
Mailing Address - Fax:254-562-1018
Practice Address - Street 1:540 CHAPEL DR
Practice Address - Street 2:
Practice Address - City:MEXIA
Practice Address - State:TX
Practice Address - Zip Code:76667-3490
Practice Address - Country:US
Practice Address - Phone:254-562-2821
Practice Address - Fax:254-562-1018
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4532207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE51592Medicare UPIN