Healthcare Provider Details

I. General information

NPI: 1023211018
Provider Name (Legal Business Name): JOEL DAVID MCLARRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 02/04/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 NE 87TH AVE SUITE 210
VANCOUVER WA
98664-1913
US

IV. Provider business mailing address

914 NE PORTLAND BOULEVARD CT
PORTLAND OR
97211-3667
US

V. Phone/Fax

Practice location:
  • Phone: 360-882-2778
  • Fax:
Mailing address:
  • Phone: 205-504-5040
  • 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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD154898
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD60569960
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: