Provider Demographics
NPI:1942275987
Name:MCCLURE, BOB E (MD)
Entity Type:Individual
Prefix:DR
First Name:BOB
Middle Name:E
Last Name:MCCLURE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:E
Other - Last Name:MCCLURE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:16702 VALLEY VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-5824
Mailing Address - Country:US
Mailing Address - Phone:714-367-5391
Mailing Address - Fax:714-635-5428
Practice Address - Street 1:16702 VALLEY VIEW AVE
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-5824
Practice Address - Country:US
Practice Address - Phone:562-921-0341
Practice Address - Fax:562-404-0266
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA411492083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACS730TMedicare PIN
CACS730ZMedicare PIN
CACS730XMedicare PIN
CACS730UMedicare PIN
CACS730YMedicare PIN
CACS730VMedicare PIN
CACS730SMedicare PIN