Provider Demographics
NPI:1033396361
Name:MCCLURE, CYNTHIA A (MD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:A
Last Name:MCCLURE
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 1:156 NORTHSHORE DR
Mailing Address - Street 2:
Mailing Address - City:KERENS
Mailing Address - State:TX
Mailing Address - Zip Code:75144-9504
Mailing Address - Country:US
Mailing Address - Phone:956-206-7633
Mailing Address - Fax:
Practice Address - Street 1:115 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:SULPHUR SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75482-2105
Practice Address - Country:US
Practice Address - Phone:903-885-7671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ80142085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
8F7568Medicare PIN
TXG48018Medicare UPIN