Organization
GARY M MCCLERNAN DPM PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY MARC MCCLERNAN D.P.M. (PRESIDENT/OWNER)
(727) 432-1919
Entity
Organization
Contact information
Practice address
14741 WATERWAY DR, HUDSON, FL 34667-3258
(727) 432-1919
(727) 260-4170
Mailing address
14741 WATERWAY DR, HUDSON, FL 34667-3258
(727) 432-1919
(727) 260-4170
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
PO2389
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019585300
—
FL
01
—
65368
BCBS
FL
01
—
65368Z
INDIVIDUAL MCARE PTAN
FL
01
—
DS9118
RR MCARE GROUP
FL
01
—
FS503A
GROUP MCARE PTAN
FL
01
—
PO2389
MEDICAL LICENSE
FL
Enumeration date
01/16/2012
Last updated
05/25/2018
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