Provider Demographics
NPI:1013004548
Name:MCCLURE, EDWARD THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:THOMAS
Last Name:MCCLURE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2200 BRYANT WILLIAMS DR FL 2
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-1121
Mailing Address - Country:US
Mailing Address - Phone:541-883-3391
Mailing Address - Fax:541-883-2250
Practice Address - Street 1:2200 BRYANT WILLIAMS DR FL 2
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-1121
Practice Address - Country:US
Practice Address - Phone:541-883-3391
Practice Address - Fax:541-883-2250
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD112222085R0204X, 2085U0001X, 208600000X, 2086S0102X, 2086S0120X, 2086S0127X, 2086S0129X, 208800000X, 2088P0231X, 208C00000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Not Answered2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Not Answered2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Not Answered2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Not Answered2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Not Answered2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Not Answered208800000XAllopathic & Osteopathic PhysiciansUrology
Not Answered2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
Not Answered208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Not Answered208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAUSA238530Medicaid
OR006213Medicaid
OR006213Medicaid
ORC93257Medicare UPIN