Individual
JAMES MCCLURE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5346 FREMONT ST, JACKSONVILLE, FL 32210-4018
(352) 427-9076
(904) 300-3558
Mailing address
5346 FREMONT ST, JACKSONVILLE, FL 32210-4018
(352) 427-9076
(904) 300-3558
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004372900
MEDICAID WAIVER PROVIDER I.D.
FL
Enumeration date
03/29/2012
Last updated
03/29/2012
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