Provider Demographics
NPI:1588760169
Name:MCLENNAN, JAMES C (MD PC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:C
Last Name:MCLENNAN
Suffix:
Gender:M
Credentials:MD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 HAMMILL LN
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-1004
Mailing Address - Country:US
Mailing Address - Phone:775-358-3522
Mailing Address - Fax:775-828-9466
Practice Address - Street 1:513 HAMMILL LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-1004
Practice Address - Country:US
Practice Address - Phone:775-358-3522
Practice Address - Fax:775-828-9466
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4536207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2016107Medicaid
NV2016107Medicaid
NV0000BDBKFMedicare ID - Type Unspecified