Provider Demographics
NPI:1447253786
Name:MCCLURE, ROBERT E (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:MCCLURE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 WALLACE AVE
Mailing Address - Street 2:
Mailing Address - City:LEITCHFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42754-1479
Mailing Address - Country:US
Mailing Address - Phone:270-879-3711
Mailing Address - Fax:270-879-8674
Practice Address - Street 1:301 SUNSET DR
Practice Address - Street 2:
Practice Address - City:CANEYVILLE
Practice Address - State:KY
Practice Address - Zip Code:42721
Practice Address - Country:US
Practice Address - Phone:270-879-3711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19396207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000363734OtherBLUE CROSS
KY1049901OtherPASSPORT
KY000000222005OtherANTHEM
KY64193964Medicaid
KY2432708000OtherPASSPORT ADVANTAGE
KY0708202Medicare PIN
KY000000222005OtherANTHEM
KY64193964Medicaid