Provider Demographics
NPI:1245296615
Name:MCCLURG, KEVIN P (PA - C)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:P
Last Name:MCCLURG
Suffix:
Gender:M
Credentials:PA - C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:709 W ORCHARD DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1766
Mailing Address - Country:US
Mailing Address - Phone:360-318-8800
Mailing Address - Fax:360-318-1085
Practice Address - Street 1:709 W ORCHARD DR
Practice Address - Street 2:SUITE 4
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1766
Practice Address - Country:US
Practice Address - Phone:360-318-8800
Practice Address - Fax:360-318-1085
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2010-12-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAPA10002821363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3976MCOtherREGENCE BLUESHIELD
WA423898000OtherGROUP HEALTH COOPERATIVE
WA8335010Medicaid
WA423898000OtherGROUP HEALTH COOPERATIVE
WA3976MCOtherREGENCE BLUESHIELD