Provider Demographics
NPI:1033123369
Name:MCCLEVE, BRYAN R (MD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:R
Last Name:MCCLEVE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:751 BLOSSOM HILL RD STE C
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-3583
Mailing Address - Country:US
Mailing Address - Phone:408-356-6650
Mailing Address - Fax:408-356-5566
Practice Address - Street 1:16325 OAKHURST DR
Practice Address - Street 2:
Practice Address - City:MONTE SERENO
Practice Address - State:CA
Practice Address - Zip Code:95030-4170
Practice Address - Country:US
Practice Address - Phone:831-566-2407
Practice Address - Fax:831-763-9799
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG75967174400000X
CA75967207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G759670Medicaid
CAF68097Medicare UPIN