Individual
WALLACE W MCLEAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
775 1ST AVE N, NAPLES, FL 34102-6005
(239) 262-3399
(239) 261-1189
Mailing address
775 1ST AVE N, NAPLES, FL 34102-6005
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
ME0025809
FL
207VG0400X
Gynecology Physician
Primary
ME0025809
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
035264100
—
FL
01
—
11094
BLUESHIELD OF FLORIDA
FL
01
—
160051557
RAILROAD MEDICARE
FL
Enumeration date
09/23/2006
Last updated
02/14/2024
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