Basic Information
Provider Information
NPI: 1053498907
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCCLENATHAN
FirstName: JAMES
MiddleName: H.
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2800 E AJO WAY
Address2:  
City: TUCSON
State: AZ
PostalCode: 857136204
CountryCode: US
TelephoneNumber: 5208742000
FaxNumber:  
Practice Location
Address1: 2800 E AJO WAY
Address2:  
City: TUCSON
State: AZ
PostalCode: 857136204
CountryCode: US
TelephoneNumber: 5208742000
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/31/2006
LastUpdateDate: 10/01/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000XG31416CAN Allopathic & Osteopathic PhysiciansSurgery 
208600000X37334AZY Allopathic & Osteopathic PhysiciansSurgery 

No ID Information.


Home