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NPI Code Detail

MEDICARE: DR. JOHN S MCCLURE MD

MEDICARE: DR. JOHN S MCCLURE MD
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
1207ZH0000XHematology (Pathology) Physician36626MN
2207ZP0102XAnatomic Pathology & Clinical Pathology Physician36626MN

General Provider Information

NPI Number : 1750340493
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN S MCCLURE MD
Provider Business Mailing Address
First Line : PO BOX 385760
Second Line :
City : BLOOMINGTON
State : MN
Zip : 55438-5760
Country : US
Telephone Number : 952-944-0970
Fax Number : 952-944-1761
Provider Business Practice Location Address
First Line : 6500 EXCELSIOR BLVD
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55426-4702
Country : US
Telephone Number : 952-993-5290
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2006
Last Update Date : 09/11/2007

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