Provider Demographics
NPI:1801893458
Name:MCCLURE, ALLEN W III (MD)
Entity type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:W
Last Name:MCCLURE
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:4239 HIGHWAY 1192
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MARKSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71351-4771
Mailing Address - Country:US
Mailing Address - Phone:318-253-7509
Mailing Address - Fax:318-253-8155
Practice Address - Street 1:4239 HIGHWAY 1192
Practice Address - Street 2:SUITE 200
Practice Address - City:MARKSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71351-4771
Practice Address - Country:US
Practice Address - Phone:318-253-7509
Practice Address - Fax:318-253-8155
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2008-08-28
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Provider Licenses
StateLicense IDTaxonomies
LA09293R208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1934810Medicaid
LAF32738Medicare UPIN
LA1934810Medicaid