Provider Demographics
NPI:1831353689
Name:LAWSON E. MCCLUNG MD. A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:LAWSON E. MCCLUNG MD. A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWSON
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:MCCLUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-759-0424
Mailing Address - Street 1:359 SAN MIGUEL DRIVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7847
Mailing Address - Country:US
Mailing Address - Phone:949-759-0424
Mailing Address - Fax:949-272-3779
Practice Address - Street 1:359 SAN MIGUEL DRIVE
Practice Address - Street 2:SUITE 303
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7847
Practice Address - Country:US
Practice Address - Phone:949-759-0424
Practice Address - Fax:949-272-3779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA36914Medicare UPIN