MEDICARE: MR. BARRY J CLEARY PA-C

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	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1518957869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BARRY J CLEARY PA-C

Provider Business Mailing Address
First Line	:	1944 JACKSONVILLE RD
Second Line	:
City	:	BAGDAD
State	:	KY
Zip	:	40003-6008
Country	:	US
Telephone Number	:	502-747-0706
Fax Number	:

Provider Business Practice Location Address
First Line	:	615 WASHINGTON ST
Second Line	:
City	:	SHELBYVILLE
State	:	KY
Zip	:	40065-1131
Country	:	US
Telephone Number	:	502-647-4668
Fax Number	:

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

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	01/07/2014

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