Provider Demographics
NPI:1457774010
Name:LAURENCE R MCCLISH MD PLLC
Entity Type:Organization
Organization Name:LAURENCE R MCCLISH MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCCLISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-348-8100
Mailing Address - Street 1:1885 S ARLINGTON AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-3370
Mailing Address - Country:US
Mailing Address - Phone:775-348-8100
Mailing Address - Fax:775-348-8101
Practice Address - Street 1:1885 S ARLINGTON AVE STE 108
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-3370
Practice Address - Country:US
Practice Address - Phone:775-348-8100
Practice Address - Fax:775-348-8101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-31
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2906207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty