MEDICARE: ERIC MCCLOUD 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	2080P0206X	Pediatric Gastroenterology Physician	G61054	CA

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	00G610540	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1386657948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC MCCLOUD M.D.

Provider Business Mailing Address
First Line	:	23560 MADISON ST
Second Line	:	STE 206
City	:	TORRANCE
State	:	CA
Zip	:	90505-4708
Country	:	US
Telephone Number	:	310-325-1229
Fax Number	:	310-325-1233

Provider Business Practice Location Address
First Line	:	23560 MADISON ST
Second Line	:	STE 206
City	:	TORRANCE
State	:	CA
Zip	:	90505-4708
Country	:	US
Telephone Number	:	310-325-1229
Fax Number	:	310-325-1233

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

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	03/22/2021

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