Basic Information
| Provider Information | |||||||||
| NPI: | 1083650386 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCLURE | ||||||||
| FirstName: | SUZANNE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 911230 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753911230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729978000 | ||||||||
| FaxNumber: | 9724379605 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 MEDICAL CENTER BLVD | ||||||||
| Address2: | |||||||||
| City: | WEBSTER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775984219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813327505 | ||||||||
| FaxNumber: | 2813327616 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2006 | ||||||||
| LastUpdateDate: | 03/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RX0202X | F6926 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | 207R00000X | F6926 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 132726402 | 05 | TX | MEDICAID | 132726408 | 05 | TX | MEDICAID | 132726401 | 05 | TX | MEDICAID | 132726409 | 05 | TX | MEDICAID | 132726403 | 05 | TX | MEDICAID | 132726407 | 05 | TX | MEDICAID | 8R1499 | 01 | TX | BLUE CROSS OF TEXAS | OTHER |