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General NPI Number Information
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NPI Number | 1174869648
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Entity Type | Individual
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Provider Name | MATTHEW CARL MCCLURE DO
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Gender | Male
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Dates
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Enumeration Date | 01/02/2013
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Last Update Date | 07/27/2016
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Provider Practice Location Address
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Address Line | 1406 6TH AVENUE NORTH ST. CLOUD HOSPITAL
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City | ST. CLOUD
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State | MN
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Zip | 56303-1901
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Country | US
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Telephone | 320-251-2700
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Fax | 320-229-5109
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Provider Business Mailing Address
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Address Line | 1900 SILVER LAKE RD NW STE 110
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City | NEW BRIGHTON
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State | MN
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Zip | 55112-1789
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Country | US
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Telephone | 651-379-1718
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Fax | 651-379-1738
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 38858
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License Number State | MN
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