Provider Demographics
NPI:1851394191
Name:MCCLURE, CHRISTOPHER COLUMBUS III (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:COLUMBUS
Last Name:MCCLURE
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:647 DUNLOP LN STE 200
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-5165
Mailing Address - Country:US
Mailing Address - Phone:931-648-0064
Mailing Address - Fax:931-553-4215
Practice Address - Street 1:647 DUNLOP LN STE 200
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-5165
Practice Address - Country:US
Practice Address - Phone:931-648-0064
Practice Address - Fax:931-553-4215
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20760207RC0000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP01376497OtherRR MEDICARE
TN3054994Medicaid
TN6011965OtherBLUE CROSS-BLUE SHIELD
TNC67561Medicare UPIN
TN3054994Medicaid
TNP01376497OtherRR MEDICARE
KYK171560Medicare PIN
TN103I061079Medicare PIN
103I061079Medicare PIN