Provider Demographics
NPI:1750564431
Name:TAMRE B. MCCLELLAND MD PA
Entity type:Organization
Organization Name:TAMRE B. MCCLELLAND MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAMRE
Authorized Official - Middle Name:B
Authorized Official - Last Name:MCCLELLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-804-0101
Mailing Address - Street 1:1919 OAKWELL FARMS PKWY
Mailing Address - Street 2:SUITE 125
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218-1777
Mailing Address - Country:US
Mailing Address - Phone:210-804-0101
Mailing Address - Fax:210-804-0201
Practice Address - Street 1:1919 OAKWELL FARMS PKWY
Practice Address - Street 2:SUITE 125
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78218-1777
Practice Address - Country:US
Practice Address - Phone:210-804-0101
Practice Address - Fax:210-804-0201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6419207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0089DEOtherBCBS
TX00689KMedicare PIN