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General NPI Number Information
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NPI Number | 1770769036
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Entity Type | Organization
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Legal Business Name | LARRY T MCCLURE, M.D.
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Dates
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Enumeration Date | 01/17/2008
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Last Update Date | 01/17/2008
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Provider Practice Location Address
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Address Line | 908 WALLACE AVE STE 103
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City | LEITCHFIELD
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State | KY
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Zip | 42754-1479
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Country | US
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Telephone | 270-259-9116
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Fax |
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Provider Business Mailing Address
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Address Line | 908 WALLACE AVE STE 103
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City | LEITCHFIELD
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State | KY
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Zip | 42754-1479
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Country | US
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Telephone | 270-259-9116
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Fax |
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Authorized Official
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Title or Position | M.D.
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Name | MR. LARRY T. MCCLURE
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Credential | M.D.
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Telephone | 270-259-9116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 18867
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License Number State | KY
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