Bruce A McLelland, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

036056311 Issued in IL

Practice address

5401 N Knoxville Ave
Suite 115
Peoria, IL 61614-5098

Phone

(309) 691-2903

Fax

(309) 691-2909

NPI assigned

Oct 10, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1397520000000",
    "number": "1689762189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5401 N KNOXVILLE AVE STE 115",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616145068",
            "telephone_number": "309-691-2903",
            "fax_number": "309-691-2909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5401 N KNOXVILLE AVE",
            "address_2": "SUITE 115",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616145098",
            "telephone_number": "309-691-2903",
            "fax_number": "309-691-2909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCLELLAND",
        "first_name": "BRUCE",
        "middle_name": "A",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-10",
        "last_updated": "2014-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IL",
            "license": "036056311",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036056311",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "P05833",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Richard Hugh McKone, DDS
• Heather McLauchlan, MD
• Emily Kathryn McLaughlin, MD
• Roxanne R McLaughlin, APRN, CNP
• Aaron M McLean, PA
• Elizabeth A McLeod
• Miranda Martin McMahan
• Dennis Q McManus, M.D.
• Meagin Abigayle McManus, OTR/L
• Holleigh Madeline McMasters, DO

• Dermatology Physician in Peoria, IL
• Providers in Peoria, IL by specialty
• Dermatology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.