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General NPI Number Information
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NPI Number | 1518957869
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Entity Type | Individual
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Provider Name | BARRY J CLEARY PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/27/2005
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Last Update Date | 01/07/2014
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Provider Practice Location Address
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Address Line | 615 WASHINGTON ST
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City | SHELBYVILLE
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State | KY
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Zip | 40065-1131
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Country | US
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Telephone | 502-647-4668
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Fax |
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Provider Business Mailing Address
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Address Line | 1944 JACKSONVILLE RD
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City | BAGDAD
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State | KY
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Zip | 40003-6008
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Country | US
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Telephone | 502-747-0706
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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