Provider Demographics
NPI:1174869648
Name:MCCLURE, MATTHEW CARL (DO)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:CARL
Last Name:MCCLURE
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Gender:M
Credentials:DO
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Mailing Address - Street 1:1900 SILVER LAKE RD NW
Mailing Address - Street 2:STE 110
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-1789
Mailing Address - Country:US
Mailing Address - Phone:651-379-1718
Mailing Address - Fax:651-379-1738
Practice Address - Street 1:1406 6TH AVENUE NORTH
Practice Address - Street 2:ST. CLOUD HOSPITAL
Practice Address - City:ST. CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-1901
Practice Address - Country:US
Practice Address - Phone:320-251-2700
Practice Address - Fax:320-229-5109
Is Sole Proprietor?:No
Enumeration Date:2013-01-02
Last Update Date:2016-07-27
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Provider Licenses
StateLicense IDTaxonomies
MN388582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry