Provider Demographics
NPI:1588869531
Name:MCCLURE, ERIKA A (MD)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:A
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 850
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-0146
Mailing Address - Country:US
Mailing Address - Phone:360-457-8578
Mailing Address - Fax:360-457-4841
Practice Address - Street 1:303 W 8TH ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-5904
Practice Address - Country:US
Practice Address - Phone:360-457-8578
Practice Address - Fax:360-457-4841
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60704464208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A942830Medicaid
CA00A942830Medicare PIN