Healthcare Provider Details

I. General information

NPI: 1497993570
Provider Name (Legal Business Name): JAMES R MCCLURG MD PROFESSIONAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2009
Last Update Date: 05/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5830 OBERLIN DR STE 102
SAN DIEGO CA
92121
US

IV. Provider business mailing address

5830 OBERLIN DR STE 102
SAN DIEGO CA
92121-3753
US

V. Phone/Fax

Practice location:
  • Phone: 619-297-9500
  • Fax: 619-297-9508
Mailing address:
  • Phone: 619-297-9500
  • Fax: 619-297-9508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG70807
License Number StateCA

VIII. Authorized Official

Name: JAMES RAFAEL MCCLURG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 619-297-9500