Provider Demographics
NPI:1013903277
Name:MCCLURKAN, MICHAEL B (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:B
Last Name:MCCLURKAN
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:PO BOX 1636
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-1636
Mailing Address - Country:US
Mailing Address - Phone:870-932-8181
Mailing Address - Fax:870-932-8193
Practice Address - Street 1:800 S CHURCH ST
Practice Address - Street 2:STE 100
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4176
Practice Address - Country:US
Practice Address - Phone:870-932-8181
Practice Address - Fax:870-932-8193
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC8287174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR129275001Medicaid
ARF76352Medicare UPIN
AR5K002Medicare ID - Type Unspecified