Provider Demographics
NPI:1538410535
Name:MCCLINTOCK, JOHNATHAN E
Entity type:Individual
Prefix:
First Name:JOHNATHAN
Middle Name:E
Last Name:MCCLINTOCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 SHORELINE TRL
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-5513
Mailing Address - Country:US
Mailing Address - Phone:469-273-3395
Mailing Address - Fax:469-273-3396
Practice Address - Street 1:3334 N TOWN EAST BLVD
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-3858
Practice Address - Country:US
Practice Address - Phone:972-279-0090
Practice Address - Fax:972-279-0090
Is Sole Proprietor?:No
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other