Provider Demographics
NPI:1588768857
Name:MC CLAIREN, WILLIE CARL JR (MD)
Entity type:Individual
Prefix:
First Name:WILLIE
Middle Name:CARL
Last Name:MC CLAIREN
Suffix:JR
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 1:315 UNIVERSITY
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-3128
Mailing Address - Country:US
Mailing Address - Phone:515-244-9950
Mailing Address - Fax:515-244-5933
Practice Address - Street 1:315 UNIVERSITY
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3128
Practice Address - Country:US
Practice Address - Phone:515-244-9950
Practice Address - Fax:515-244-5933
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA27700208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery