Provider Demographics
NPI:1427255512
Name:MCCLURE, MATTHEW VINCENT (IDC)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:VINCENT
Last Name:MCCLURE
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 ASH PL
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28542-8564
Mailing Address - Country:US
Mailing Address - Phone:910-451-7821
Mailing Address - Fax:910-451-7821
Practice Address - Street 1:BLDG 111 C ST
Practice Address - Street 2:
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28542-0084
Practice Address - Country:US
Practice Address - Phone:910-451-7821
Practice Address - Fax:910-451-7821
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman