Provider Demographics
NPI:1023220167
Name:MCCLOUGH, DANIEL JOSEPH (PA)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JOSEPH
Last Name:MCCLOUGH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4597 COUNTY RD FF
Mailing Address - Street 2:
Mailing Address - City:ORLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95963
Mailing Address - Country:US
Mailing Address - Phone:530-865-3994
Mailing Address - Fax:
Practice Address - Street 1:706 PEACH ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:CA
Practice Address - Zip Code:96021-3355
Practice Address - Country:US
Practice Address - Phone:530-690-2827
Practice Address - Fax:784-168-1989
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13458363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant