Provider Demographics
NPI:1285602953
Name:MCMAHON, CLETUS J JR (MD)
Entity type:Individual
Prefix:DR
First Name:CLETUS
Middle Name:J
Last Name:MCMAHON
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:90 VERMONT AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6474
Mailing Address - Country:US
Mailing Address - Phone:865-481-2541
Mailing Address - Fax:865-483-8151
Practice Address - Street 1:90 VERMONT AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6478
Practice Address - Country:US
Practice Address - Phone:865-481-2541
Practice Address - Fax:865-483-8151
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2017-06-22
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Provider Licenses
StateLicense IDTaxonomies
TNMD9051207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN200029629OtherRAILROAD MEDICARE
TN3071421OtherBLUE CROSS BLUE SHIELD
TN4034705OtherAETNA
TN100010938OtherTENNCARE
TN3168046Medicaid
TN296033OtherUNITED HEALTH CARE
B03258Medicare UPIN
TN103I206756Medicare PIN
TN3071421OtherBLUE CROSS BLUE SHIELD
TN100010938OtherTENNCARE
TN3168048Medicare PIN
TNTN0186OtherJOHN DEERE HEALTHCARE
TN103I209261Medicare PIN
TNTN0138OtherJOHN DEERE HEALTHCARE