Doctor Name: | WALLACE MCCLURE |
NPI Number: | 1407266653 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | MD4230 |
Business Practice Address: | 450 Powers Blvd. Waverly, TN - 37185 |
Business Phone Number: | 9312962054 |
Business Fax Number: | |
Mailing Address: | 450 Powers Blvd., WAVERLY |
State: | TN |
Postal Code: | 37185 |
Phone Number: | 9312962054 |
Fax Number: | |
NPI Enumeration Date: | 04/28/2014 |
NPI Last Update Date: | 04/28/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | MD4230 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |