Individual
MATTHEW BRUCE MCCLELLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
C.P.O.
Contact information
Practice address
1122 E FRONT ST, TYLER, TX 75702-8414
(903) 592-6574
(903) 595-3862
Mailing address
1122 E FRONT ST, TYLER, TX 75702-8414
(903) 592-6574
(903) 595-3862
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
2047
TX
224P00000X
Prosthetist
Primary
2047
TX
Other
Enumeration date
04/29/2020
Last updated
04/29/2020
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