Provider Demographics
NPI:1386657948
Name:MCCLOUD, ERIC (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:MCCLOUD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23560 MADISON ST
Mailing Address - Street 2:STE 206
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4708
Mailing Address - Country:US
Mailing Address - Phone:310-325-1229
Mailing Address - Fax:310-325-1233
Practice Address - Street 1:23560 MADISON ST
Practice Address - Street 2:STE 206
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4708
Practice Address - Country:US
Practice Address - Phone:310-325-1229
Practice Address - Fax:310-325-1233
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG610542080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G610540Medicaid
CA00G610540OtherBLUE SHIELD