Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | MD11222 | OR |
N | 208600000X | Surgeon | MD11222 | OR |
N | 2086S0102X | Surgical Critical Care | MD11222 | OR |
N | 2086S0120X | Pediatric Surgery | MD11222 | OR |
N | 2086S0127X | Trauma Surgeon | MD11222 | OR |
N | 2086S0129X | Vascular Surgeon | MD11222 | OR |
N | 208800000X | Urologist | MD11222 | OR |
N | 2088P0231X | Pediatric Urologist | MD11222 | OR |
N | 208C00000X | Colorectal Surgeon | MD11222 | OR |
N | 208G00000X | Cardiothoracic Vascular Surgeon | MD11222 | OR |
NPI | 1013004548 |
---|---|
Provider Name | Edward Thomas Mcclure |
First Address | Klamath Falls, OR 97601-1121 |
Second Address | Klamath Falls, OR 97601-1121 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006213 | (05) | OR |
C93257 | (02) | OR |
USA238530 | (05) | CA |