MEDICARE: DOUGLAS G MCCLURE PSY.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	103TC0700X	Clinical Psychologist	1313	OR

General Provider Information

NPI Number	:	1194854562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS G MCCLURE PSY.D.

Provider Business Mailing Address
First Line	:	15880 QUARRY RD
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97035-3336
Country	:	US
Telephone Number	:	503-697-1800
Fax Number	:	503-228-7197

Provider Business Practice Location Address
First Line	:	15880 QUARRY RD
Second Line	:
City	:	LAKE OSWEGO
State	:	OR
Zip	:	97035-3336
Country	:	US
Telephone Number	:	503-697-1800
Fax Number	:	503-228-7197

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

Provider Enumeration Date	:	03/03/2007
Last Update Date	:	07/08/2007

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