Healthcare Provider Details

I. General information

NPI: 1356550438
Provider Name (Legal Business Name): MEGAN CLARY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 10/05/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3217 S PROVIDENCE RD
COLUMBIA MO
65203-3639
US

IV. Provider business mailing address

PO BOX 7687
COLUMBIA MO
65205-7687
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-4730
  • Fax: 573-884-4899
Mailing address:
  • Phone: 573-882-2259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01065337
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2011035524
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: