Provider Demographics
NPI:1215130612
Name:MCLENDON, JOHN PAUL (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:PAUL
Last Name:MCLENDON
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 2705
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35804-2705
Mailing Address - Country:US
Mailing Address - Phone:256-265-7981
Mailing Address - Fax:
Practice Address - Street 1:245 GOVERNORS DR SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-2700
Practice Address - Country:US
Practice Address - Phone:256-265-7981
Practice Address - Fax:256-265-4987
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.29377207P00000X, 208000000X
OH35148584208000000X, 208M00000X
MS32055208M00000X
AL29377208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-05876OtherBCBS
ALZ10928OtherVIVA HEALTH
AL1215130612OtherTRICARE SOUTH
AL129212Medicaid
AL138594Medicaid
OH0019370Medicaid
AL511-06565OtherBCBS