Provider Demographics
NPI:1497993570
Name:JAMES R MCCLURG MD PROFESSIONAL CORP
Entity Type:Organization
Organization Name:JAMES R MCCLURG MD PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RAFAEL
Authorized Official - Last Name:MCCLURG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-297-9500
Mailing Address - Street 1:5830 OBERLIN DR STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-3753
Mailing Address - Country:US
Mailing Address - Phone:619-297-9500
Mailing Address - Fax:619-297-9508
Practice Address - Street 1:5830 OBERLIN DR STE 102
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121
Practice Address - Country:US
Practice Address - Phone:619-297-9500
Practice Address - Fax:619-297-9508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-28
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG70807174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1306817895OtherNPI
F19652Medicare UPIN