Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 19730 | NE |
NPI | 1114920592 |
---|---|
Provider Name | Dr. John William Mcclellan III |
First Address | Omaha, NE 68154-5335 |
Second Address | Omaha, NE 68154-5335 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2005 |
Last Update Date | 28/01/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00094 | BCBS (01) | NE |
1514281 | (05) | NE |
200037481 | RAILROAD MEDICARE (01) | NE |
47081304012 | (05) | NE |
G04151 | (02) | NE |