Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | MD-11518 | HI |
NPI | 1124090766 |
---|---|
Provider Name | Dr. Bruce Martin Mcclenathan |
First Address | Fort Bragg, NC 28310 |
Second Address | Fort Bragg, NC 28310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2006 |
Last Update Date | 08/07/2007 |