Provider Demographics
NPI:1770550311
Name:MCCLURE, KENNETH E (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:E
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:PO BOX 19036
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4085
Mailing Address - Country:US
Mailing Address - Phone:903-232-1622
Mailing Address - Fax:
Practice Address - Street 1:802 MEDICAL DR STE 300
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5204
Practice Address - Country:US
Practice Address - Phone:903-232-1622
Practice Address - Fax:903-753-0760
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7479207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163030303Medicaid
TXTXB147329Medicare PIN
TXH57244Medicare UPIN