Provider Demographics
NPI:1093763542
Name:MCCLAIN, GREGORY DEWAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:DEWAYNE
Last Name:MCCLAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 800022
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-0022
Mailing Address - Country:US
Mailing Address - Phone:800-953-0104
Mailing Address - Fax:303-765-6670
Practice Address - Street 1:1020 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-3508
Practice Address - Country:US
Practice Address - Phone:719-557-3777
Practice Address - Fax:719-557-3775
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013025596208600000X
FLME101924208600000X
CODR.0055743208600000X, 207R00000X
WI1489-TEP208600000X
TXN3408208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine