Provider Demographics
NPI:1497757579
Name:MCCLURE, JEFFREY B (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:B
Last Name:MCCLURE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3170 KETTERING BLVD BLDG B2ND
Mailing Address - Street 2:
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1924
Mailing Address - Country:US
Mailing Address - Phone:937-991-3188
Mailing Address - Fax:517-265-0313
Practice Address - Street 1:3006 N COUNTY ROAD 25A STE 104
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-1373
Practice Address - Country:US
Practice Address - Phone:937-335-3518
Practice Address - Fax:937-332-6857
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35076436M207RC0000X
MI4301075411207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2143031Medicaid
P00433150OtherRRMC
MI000000521478OtherANTHEM
MI1497757579Medicaid
433741OtherPRIORITY HEALTH
OH2143031Medicaid
7637005OtherAETNA
161955OtherGLHP
03440OtherPARAMOUNT
0604601792OtherBCBS MI
MI9980OtherHPM
MI5183807Medicaid
433741OtherPRIORITY HEALTH
OHMC4147743Medicare ID - Type Unspecified