Provider Demographics
NPI:1134111784
Name:MCCLURE, LARRY T (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:T
Last Name:MCCLURE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSON
Mailing Address - State:KY
Mailing Address - Zip Code:42726-7044
Mailing Address - Country:US
Mailing Address - Phone:866-653-8232
Mailing Address - Fax:270-242-0579
Practice Address - Street 1:619 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CLARKSON
Practice Address - State:KY
Practice Address - Zip Code:42726
Practice Address - Country:US
Practice Address - Phone:866-653-8232
Practice Address - Fax:270-242-0579
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1121036OtherPASSPORT
KY175904OtherANTHEM
KY64188675Medicaid
KY1121036OtherPASSPORT
C71576Medicare UPIN