Derek McClure, BOCPO

Primary specialty

ProsthetistTaxonomy code 224P00000X

License

C46700 Issued in AZ

Practice address

3433 Broadway St
Ste. # B3
American Canyon, CA 94503-1229

Phone

(707) 643-2177

Fax

(707) 643-6339

NPI assigned

Jul 22, 2014

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1405987200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405987200000",
    "number": "1477960466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3433 BROADWAY ST",
            "address_2": "STE. # B3",
            "city": "AMERICAN CANYON",
            "state": "CA",
            "postal_code": "945031229",
            "telephone_number": "707-643-2177",
            "fax_number": "707-643-6339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3433 BROADWAY ST",
            "address_2": "STE. # B3",
            "city": "AMERICAN CANYON",
            "state": "CA",
            "postal_code": "945031229",
            "telephone_number": "707-643-2177",
            "fax_number": "707-643-6339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCLURE",
        "first_name": "DEREK",
        "credential": "BOCPO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-22",
        "last_updated": "2014-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224P00000X",
            "taxonomy_group": "",
            "desc": "Prosthetist",
            "state": "AZ",
            "license": "C46700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gerardo Baluyut Manansala, M.D.
• Paul Manuzon
• Jordan Martinez
• Sergio Sanchez Martinez
• Elizabeth Barg Martorana, PA-C
• Thomas Michael McCombs, DO
• Gary L McCorkle, P.A.
• Karen McCrary, BCBA
• McGrew Behavior Intervention Services, Inc.
• McGrew Behavioral Health Services, Inc.

• Prosthetist in American Canyon, CA
• Providers in American Canyon, CA by specialty
• Prosthetist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.