Provider Demographics
NPI:1134167687
Name:MCCLINTOCK, JEAN HELEN (MD)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:HELEN
Last Name:MCCLINTOCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14810 OLD SAINT AUGUSTINE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-2451
Mailing Address - Country:US
Mailing Address - Phone:904-512-1899
Mailing Address - Fax:904-503-1052
Practice Address - Street 1:7711 BAYMEADOWS RD E STE 6
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-9110
Practice Address - Country:US
Practice Address - Phone:904-731-1770
Practice Address - Fax:904-996-8300
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71302207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL31588OtherBCBS
FL11003OtherWELLCARE
FL11003OtherWELLCARE
FL31588YMedicare PIN
FLP00123879Medicare PIN
FL31588OtherBCBS