Provider Demographics
NPI:1255432530
Name:MCCLURE, RICKY EDWARD (DPM)
Entity type:Individual
Prefix:DR
First Name:RICKY
Middle Name:EDWARD
Last Name:MCCLURE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 GOLF VIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-9643
Mailing Address - Country:US
Mailing Address - Phone:541-770-1225
Mailing Address - Fax:541-770-1245
Practice Address - Street 1:713 GOLF VIEW DRIVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-9643
Practice Address - Country:US
Practice Address - Phone:541-770-1225
Practice Address - Fax:541-770-1245
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00272213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1297890001OtherREGION D DMERC CIGNA HC
OR230478Medicaid
T86397Medicare UPIN
ORR118327Medicare PIN
1297890001OtherREGION D DMERC CIGNA HC