Provider Demographics
NPI:1417960709
Name:CLEARY, JOEL EDWARD (MD, MHA)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:EDWARD
Last Name:CLEARY
Suffix:
Gender:M
Credentials:MD, MHA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:607 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GRANGEVILLE
Mailing Address - State:ID
Mailing Address - Zip Code:83530-1345
Mailing Address - Country:US
Mailing Address - Phone:208-983-8590
Mailing Address - Fax:208-983-8580
Practice Address - Street 1:607 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GRANGEVILLE
Practice Address - State:ID
Practice Address - Zip Code:83530-1345
Practice Address - Country:US
Practice Address - Phone:208-983-8590
Practice Address - Fax:208-983-8580
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MT7367207X00000X
NM81-31207X00000X
WAMD00024662207X00000X
IDM7138207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery