Healthcare Provider Details

I. General information

NPI: 1710106000
Provider Name (Legal Business Name): PETER CHRISTOPHER MCCLURE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVE
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

3700 MADRONE AVE
OAKLAND CA
94619-2708
US

V. Phone/Fax

Practice location:
  • Phone: 415-206-8000
  • Fax:
Mailing address:
  • Phone: 510-336-0594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA87786
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: