Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 3023 | TX |
Y | 222Z00000X | Podiatrist | 3023 | TX |
NPI | 1053838177 |
---|---|
Provider Name | Dr. Courtney Mcclurkin |
First Address | Neptune, NJ 07753-4859 |
Second Address | Dallas, TX 75230-2535 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2017 |
Last Update Date | 17/06/2020 |