Provider Demographics
NPI:1578646329
Name:MCCLURE, MICHAEL JAMES (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAMES
Last Name:MCCLURE
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 WOOD ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-7903
Mailing Address - Country:US
Mailing Address - Phone:941-364-9515
Mailing Address - Fax:941-364-9518
Practice Address - Street 1:2055 WOOD ST
Practice Address - Street 2:SUITE 104
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-7903
Practice Address - Country:US
Practice Address - Phone:941-364-9515
Practice Address - Fax:941-364-9518
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME917652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME91765OtherSTATE MEDICAL LICENSE
FLME91765OtherSTATE MEDICAL LICENSE
FLBM6091691OtherDEA NUMBER