Healthcare Provider Details

I. General information

NPI: 1154680668
Provider Name (Legal Business Name): BRIAN ROBERT CLEAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2012
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 WESTLAKE AVE N STE 200
SEATTLE WA
98109-6212
US

IV. Provider business mailing address

1768 9TH ST
OAKLAND CA
94607-1341
US

V. Phone/Fax

Practice location:
  • Phone: 866-337-2566
  • Fax:
Mailing address:
  • Phone: 510-731-7315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA148861
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number47916
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME 124874
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberME124874
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberA148861
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: