Provider Demographics
NPI:1518040005
Name:MCENTYRE, CLINTON ERLE (MD)
Entity Type:Individual
Prefix:
First Name:CLINTON
Middle Name:ERLE
Last Name:MCENTYRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CLINTON
Other - Middle Name:ERLE
Other - Last Name:MCENTYRE
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4310 WATERMELON RD
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35473-5166
Mailing Address - Country:US
Mailing Address - Phone:205-330-5266
Mailing Address - Fax:205-330-9915
Practice Address - Street 1:4310 WATERMELON RD
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473-5166
Practice Address - Country:US
Practice Address - Phone:205-330-5266
Practice Address - Fax:205-330-9915
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20976207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-00517OtherBCBS OF AL.
AL1336474964/115060Medicaid
ALP00802676OtherMEDICARE RAILROAD
AL511-00517OtherBCBS OF AL.
AL102I087868Medicare PIN