Organization
GAIL K MCCLAVE MD LLC
Active
Other names
LLC
Organization subpart
No
Provider details
NPI number
Authorized official
GAIL KOCH MCCLAVE MD (OWNER)
(541) 347-2111
Entity
Organization
Contact information
Practice address
475 ELMIRA AVE SE, SUITE 103, BANDON, OR 97411-7405
(541) 347-2111
(541) 347-1212
Mailing address
PO BOX 393, BANDON, OR 97411
(541) 347-2111
(541) 347-1212
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
287386
—
OR
Enumeration date
11/02/2006
Last updated
05/16/2014
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