Provider Demographics
NPI:1588263958
Name:MCCLURE, PHYLLIS ANN
Entity type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:ANN
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 HEATHERLY CT
Mailing Address - Street 2:
Mailing Address - City:EASTOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28312-7619
Mailing Address - Country:US
Mailing Address - Phone:910-703-8028
Mailing Address - Fax:
Practice Address - Street 1:1506 HEATHERLY CT
Practice Address - Street 2:
Practice Address - City:EASTOVER
Practice Address - State:NC
Practice Address - Zip Code:28312-7619
Practice Address - Country:US
Practice Address - Phone:910-702-8028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-18
Last Update Date:2020-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1246802085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty