Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 31847 | AL |
N | 2080P0210X | Pediatric Nephrologist | 31847 | AL |
NPI | 1770618498 |
---|---|
Provider Name | Dr. Robert Bradley Mcclellan |
First Address | Huntsville, AL 35804-2705 |
Second Address | Huntsville, AL 35801-2700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2007 |
Last Update Date | 01/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
31847 | AL LICENSE (01) | AL |