Provider Demographics
NPI:1346313905
Name:DARYN MCCLURE, M.D., PC
Entity Type:Organization
Organization Name:DARYN MCCLURE, M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DARYN
Authorized Official - Middle Name:N
Authorized Official - Last Name:MCCLURE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-987-0987
Mailing Address - Street 1:20715 E OCOTILLO RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-6118
Mailing Address - Country:US
Mailing Address - Phone:480-987-0987
Mailing Address - Fax:480-987-0940
Practice Address - Street 1:20715 E OCOTILLO RD
Practice Address - Street 2:SUITE 102
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-6118
Practice Address - Country:US
Practice Address - Phone:480-987-0987
Practice Address - Fax:480-987-0940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ75461Medicaid
AZZ75461Medicaid