Provider Demographics
NPI:1992749493
Name:MCCLENDON, EDWARD BRUCE (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:BRUCE
Last Name:MCCLENDON
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 1:11830 FM 1960 RD W
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-3840
Mailing Address - Country:US
Mailing Address - Phone:281-890-3010
Mailing Address - Fax:281-894-6302
Practice Address - Street 1:11830 FM 1960 RD W
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-3840
Practice Address - Country:US
Practice Address - Phone:281-890-3010
Practice Address - Fax:281-894-6302
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1972207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD66917Medicare UPIN
00805UMedicare ID - Type Unspecified