Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 1269 | NE |
NPI | 1104046945 |
---|---|
Provider Name | Dr. John William Mcclaren |
First Address | La Vista, NE 68128-2354 |
Second Address | La Vista, NE 68128-2354 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 09/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
47084486100 | (05) | NE |
99512 | BLUE CROSS BLUE SHIELD ID (01) | NE |
U87162 | (02) | NE |