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Organization

CLEARY MEDICAL ASSOCIATES, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
TIMOTHY SHANNAHAN CLEARY MD (SOLE MEMBER)
(503) 520-0777
Entity
Organization

Contact information

Practice address
11786 SW BARNES RD, STE 270, PORTLAND, OR 97225-5929
(503) 520-0777
(503) 520-0559
Mailing address
PO BOX 23200, PORTLAND, OR 97281-3200
(503) 520-0777
(503) 520-0559

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
13852
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
109009
OR
Enumeration date
06/22/2005
Last updated
10/16/2007
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