DR. DEEDRA GAIL MCLAIN (NPI# 1770635062) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1770635062 |
Entity Type | Individual |
Full Name | DR. DEEDRA GAIL MCLAIN |
Other Name | DEEDRA G CORZART |
Credential | M.D. |
Practice Address |
300 W Oak St Carbondale IL 62901-1400 |
Mailing Address |
Po Box 19639 Springfield IL 62794-9639 |
Practice Telephone | 6185366621 |
Mailing Telephone | 2175453787 |
Enumeration Date | 2007-01-17 |
Last Update Date | 2020-07-07 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 207Q00000X | Family Medicine | 036107216 | IL | Allopathic & Osteopathic Physicians |
Y | 208D00000X | General Practice | 036107216 | IL | Allopathic & Osteopathic Physicians |
Address | Telephone Number | Fax Number |
---|---|---|
2553 Ken Gray Blvd, West Frankfort, IL 628964174 | 6189323937 | 6189322734 |
Street Address |
300 W OAK ST |
City | CARBONDALE |
State | IL |
Zip Code | 62901-1400 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1104443258 | Kilmeny Clark | Student in an Organized Health Care Education/Training Program | 300 W Oak St, Carbondale, IL 62901-1400 | 2020-07-05 |
1033734272 | Kristina Klaverkamp | Physician Assistant | 300 W Oak St, Carbondale, IL 62901-1400 | 2020-06-13 |
1891310546 | Rustambir Singh | Family Medicine | 300 W Oak St, Carbondale, IL 62901-1400 | 2020-06-09 |
1144845884 | Brian Scott Wilkinson | Family Medicine | 300 W Oak St, Carbondale, IL 62901-1400 | 2020-06-09 |
1699390344 | Claire Francesca Melo | Family Medicine | 300 W Oak St, Carbondale, IL 62901-1400 | 2020-06-09 |
1548884398 | Amanda Durham | Student in an Organized Health Care Education/Training Program | 300 W Oak St, Carbondale, IL 62901-1400 | 2020-06-07 |
1184248627 | Serhiy Maslovsky | Student in an Organized Health Care Education/Training Program | 300 W Oak St, Carbondale, IL 62901-1400 | 2020-06-01 |
1306460902 | Kendall Barnes | Physician Assistant | 300 W Oak St, Carbondale, IL 62901-1400 | 2020-05-31 |
1578186755 | Zachary Carty | Physician Assistant | 300 W Oak St, Carbondale, IL 62901-1400 | 2020-05-22 |
1194347765 | Kara Jordan Freeman | Physician Assistant | 300 W Oak St, Carbondale, IL 62901-1400 | 2020-05-17 |
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1558961268 | Gerad Aaron Harsy | Pharmacist | Walmart Pharmcy, 1450 East Main St, Carbondale, IL 62901 | 2020-10-30 |
1437708674 | Board of Trustees of Southern Illinois University | Clinic/Center | 300 W Oak Street, Carbondale, IL 62901 | 2019-09-10 |
1306317383 | Rachael O Johnson | Nurse Practitioner | 404 S. Lewis Ln, Carbondale, IL 62901 | 2018-12-17 |
1740795194 | Megan Marie Zimmerman | Nurse Practitioner | 1100 W Diann Ln., Carbondale, IL 62901 | 2017-12-07 |
1295244242 | Amy Elizabeth Prudencio | Social Worker | 1301 E. Walnut Street, Carbondale, IL 62901 | 2017-09-21 |
1740708171 | Theresa Aleise Goodin | Speech-Language Pathologist | 1301 East Walnut Street, Carbondale, IL 62901 | 2017-09-06 |
1144762527 | Kathleen Chwalisz Rigney | Psychologist | 306 West Mill Street, Neurorestorative, Carbondale, IL 62901 | 2016-11-16 |
1285185173 | Shawnee Health Service and Development Corp | Social Worker | 404 S. Lewis Lane, Carbondale, IL 62901 | 2016-10-17 |
1437605094 | Arielle Greer | Nurse's Aide | 510 E. Russell St., A, Carbondale, IL 62901 | 2016-09-01 |
1518413863 | Complete Family Eyecare of Carbondale, PC | Optometrist | 1241 East Walnut Street, Carbondale, IL 62901 | 2016-08-28 |
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Taxonomy Code | 208D00000X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | General Practice |
Definition to come... |
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City | CARBONDALE |
Zip Code | 62901 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.