Individual
DR. GERALD WAYNE MCCLALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2 S HOSPITAL DR, MURPHYSBORO, IL 62966-3333
(618) 684-3156
(618) 529-0524
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(800) 457-5200
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036-078422
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
046749
HEALTH ALLIANCE
—
Enumeration date
05/16/2006
Last updated
09/27/2021
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