Individual
DR. BRUCE CLARK MCCLELLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1717 W COWLES ST, FAIRBANKS, AK 99701-5926
(907) 451-6682
Mailing address
PO BOX 787, MORGAN, UT 84050-0787
(801) 821-6541
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
188674-8905
UT
207Q00000X
Family Medicine Physician
Primary
43497-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1386731883
—
WI
Enumeration date
10/06/2006
Last updated
09/20/2024
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