Provider Demographics
NPI:1952324402
Name:MCCLURE, THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:MCCLURE
Suffix:
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 1:732 SUMMITVIEW AVE # 621
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3032
Mailing Address - Country:US
Mailing Address - Phone:509-575-5058
Mailing Address - Fax:509-575-5196
Practice Address - Street 1:206 S 11TH AVE
Practice Address - Street 2:SUITE 48
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3205
Practice Address - Country:US
Practice Address - Phone:509-575-5058
Practice Address - Fax:509-575-5196
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG480692083X0100X
WAMD602226872083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G480690Medicaid
CAH76449Medicare UPIN
CA00G480690Medicare ID - Type Unspecified