Provider Demographics
NPI:1497757579
Name:MCCLURE, JEFFREY B (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:B
Last Name:MCCLURE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:818 RIVERSIDE AVE
Mailing Address - Street 2:5TH FLOOR CARDIOLOGY
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1446
Mailing Address - Country:US
Mailing Address - Phone:517-265-0326
Mailing Address - Fax:517-265-0313
Practice Address - Street 1:818 RIVERSIDE AVE
Practice Address - Street 2:5TH FLOOR CARDIOLOGY
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1446
Practice Address - Country:US
Practice Address - Phone:517-265-0326
Practice Address - Fax:517-265-0313
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2023-11-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35076436M207RC0000X
MI4301075411207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5183807Medicaid
P00433150OtherRRMC
MI000000521478OtherANTHEM
MI1497757579Medicaid
433741OtherPRIORITY HEALTH
OH2143031Medicaid
7637005OtherAETNA
161955OtherGLHP
03440OtherPARAMOUNT
0604601792OtherBCBS MI
MI9980OtherHPM
MI5183807Medicaid
433741OtherPRIORITY HEALTH
OHMC4147743Medicare ID - Type Unspecified