MEDICARE: THOMAS G. MCCLEARY DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	005476	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	116913561	OTHER		RAILROAD MEDICARE

General Provider Information

NPI Number	:	1124069968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS G. MCCLEARY DO

Provider Business Mailing Address
First Line	:	3200 N WINDSONG DR
Second Line	:
City	:	PRESCOTT VALLEY
State	:	AZ
Zip	:	86314-2255
Country	:	US
Telephone Number	:	928-772-1505
Fax Number	:	928-772-6343

Provider Business Practice Location Address
First Line	:	3200 N WINDSONG DR
Second Line	:
City	:	PRESCOTT VALLEY
State	:	AZ
Zip	:	86314-2255
Country	:	US
Telephone Number	:	928-772-1505
Fax Number	:	928-772-6343

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	02/21/2011

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Directions to “ THOMAS G. MCCLEARY DO” Practice Location

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