Provider Demographics
NPI:1356999056
Name:MCCLUNG, ROXANNE ZAREL (MD)
Entity type:Individual
Prefix:
First Name:ROXANNE
Middle Name:ZAREL
Last Name:MCCLUNG
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 1:11937 US HIGHWAY 271
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75708-3154
Mailing Address - Country:US
Mailing Address - Phone:903-877-7777
Mailing Address - Fax:972-388-2009
Practice Address - Street 1:400 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-4302
Practice Address - Country:US
Practice Address - Phone:972-524-4159
Practice Address - Fax:972-388-2009
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10075249390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program