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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