Healthcare Provider Details

I. General information

NPI: 1609210269
Provider Name (Legal Business Name): RYAN K CLEARY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2013
Last Update Date: 11/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 GLENWOOD DR STE 200
CHATTANOOGA TN
37404
US

IV. Provider business mailing address

605 GLENWOOD DR STE 200
CHATTANOOGA TN
37404-1130
US

V. Phone/Fax

Practice location:
  • Phone: 423-698-1844
  • Fax: 423-624-2226
Mailing address:
  • Phone: 423-495-7739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number57047
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: