MEDICARE: DR. MARK WARREN MCCLURE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	33672	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0113J	OTHER	NC	BCBS

General Provider Information

NPI Number	:	1083627624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK WARREN MCCLURE M.D.

Provider Business Mailing Address
First Line	:	221B PROFESSIONAL CIR
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-4303
Country	:	US
Telephone Number	:	252-247-2101
Fax Number	:	252-247-9469

Provider Business Practice Location Address
First Line	:	221B PROFESSIONAL CIR
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-4303
Country	:	US
Telephone Number	:	252-247-2101
Fax Number	:	252-247-9469

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	12/08/2014

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