Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 2301002158 | MI |
NPI | 1588660005 |
---|---|
Provider Name | Dr. Jerry D Mcclane |
First Address | Mount Morris, MI 48458-9347 |
Second Address | Mount Morris, MI 48458-9347 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T82888 | (02) | MI |