Healthcare Provider Details

I. General information

NPI: 1437262573
Provider Name (Legal Business Name): TIMOTHY PATRICK MCCLURE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 11/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 SHACKLEFORD PLZ STE 207
LITTLE ROCK AR
72211-1853
US

IV. Provider business mailing address

3410 FOXCROFT RD
LITTLE ROCK AR
72227-2330
US

V. Phone/Fax

Practice location:
  • Phone: 501-224-7191
  • Fax:
Mailing address:
  • Phone: 501-414-0089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberE-5001
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberT2006-117
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: