Provider Demographics
NPI:1366704710
Name:MCCLOY, THOMAS MCKELLAR (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MCKELLAR
Last Name:MCCLOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 918
Mailing Address - Street 2:
Mailing Address - City:TWISP
Mailing Address - State:WA
Mailing Address - Zip Code:98856-0918
Mailing Address - Country:US
Mailing Address - Phone:509-201-3563
Mailing Address - Fax:509-246-0690
Practice Address - Street 1:214 GLOVER ST. NORTH
Practice Address - Street 2:
Practice Address - City:TWISP
Practice Address - State:WA
Practice Address - Zip Code:98856
Practice Address - Country:US
Practice Address - Phone:509-337-5005
Practice Address - Fax:509-246-0690
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60481744207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1992403729Medicaid