Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 04-24068 | KS |
N | 208200000X | Surgeon | 04-24068 | KS |
N | 208600000X | Surgeon | 04-24068 | KS |
N | 2086S0102X | Surgical Critical Care | 04-24068 | KS |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 04-24068 | KS |
NPI | 1316997158 |
---|---|
Provider Name | Thomas Richard Mclean |
First Address | Leavenworth, KS 66048-5014 |
Second Address | Leavenworth, KS 66048-5014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 05/09/2013 |