Healthcare Provider Details

I. General information

NPI: 1932698727
Provider Name (Legal Business Name): KATHERINE MCCLURE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2018
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4530 E SHEA BLVD STE 101
PHOENIX AZ
85028-6066
US

IV. Provider business mailing address

PO BOX 61025
PHOENIX AZ
85082-1025
US

V. Phone/Fax

Practice location:
  • Phone: 602-867-7546
  • Fax: 602-971-0065
Mailing address:
  • Phone: 480-681-3300
  • Fax: 480-681-3301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number011082
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: