Provider Demographics
NPI:1144341306
Name:MCCLURE, EMILY MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:MARIE
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:EMILY
Other - Middle Name:MARIE
Other - Last Name:MCCLURE SANTALIZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1201 SOMERVILLE RD SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-4340
Mailing Address - Country:US
Mailing Address - Phone:256-355-1216
Mailing Address - Fax:256-355-1655
Practice Address - Street 1:1201 SOMERVILLE RD SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-4340
Practice Address - Country:US
Practice Address - Phone:256-355-1216
Practice Address - Fax:256-355-1655
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.21689207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051517978OtherBC BS C PLUS
AL200284020OtherTRICARE
AL051517978OtherBLUE ADVANTAGE
ALP00093289OtherRAILROAD MEDICARE
AL051517978OtherBLUECROSS BLUESHIELD, AL2
AL20028402035601A001OtherTRICARE FOR LIFE
AL051517978OtherBLUECROSS BLUESHIELD, AL
AL20028402035601A001OtherTRICARE
AL051517978OtherBLUE ADVANTAGE
AL200284020OtherTRICARE
AL051517978Medicare ID - Type UnspecifiedMEDICARE PT B ALABAMA