Provider Demographics
NPI:1750377198
Name:MCCLANAHAN, MARK LEE (DO)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:LEE
Last Name:MCCLANAHAN
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1806 QUINCY ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:79072-4206
Mailing Address - Country:US
Mailing Address - Phone:806-288-7891
Mailing Address - Fax:806-288-7920
Practice Address - Street 1:1806 QUINCY ST
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:TX
Practice Address - Zip Code:79072-4206
Practice Address - Country:US
Practice Address - Phone:806-288-7891
Practice Address - Fax:806-288-7920
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2022-05-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXH4531207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080172851OtherRAILROAD MEDICARE
TX173682902OtherMEDICAID HOME HEALTH DME
TX370622800OtherUS DEPT OF LABOR
TX108548OtherSUPERIOR HEALTH PLAN
TX140688601Medicaid
TX3089010001OtherPALMETTO GBA
TX762270OtherPHOENIX HEALTH PLAN
TX811020OtherUSA MANAGED CARE PPO
TX143179307Medicaid
TX143179308Medicaid
TX173682901OtherMEDICAID DME
TX615010000OtherUS DEPT OF LABOR
TX125516200OtherUS WORKER'S COMPENSATION
TX133737005Medicaid
NME4655OtherNEW MEXICO MEDICAID
TX118927100OtherFIRST CARE
TX143179310Medicaid
TX1LEW01644OtherTUHP
TX00A46QOtherBLUE CROSS BLUE SHIELD
CO23386533OtherCOLORADO MEDICAID
TXA67394Medicare UPIN
TX143179310Medicaid