Healthcare Provider Details

I. General information

NPI: 1679826275
Provider Name (Legal Business Name): CHRISTOPHER DUKE MCCLURE H.A.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2012
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 PALM COAST PKWY SW STE 109
PALM COAST FL
32137-4747
US

IV. Provider business mailing address

750 N COMMONS DR STE 200
AURORA IL
60504-7940
US

V. Phone/Fax

Practice location:
  • Phone: 386-447-3530
  • Fax: 386-447-3633
Mailing address:
  • Phone: 630-303-5380
  • Fax: 630-303-5385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS 4823
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: