Provider Demographics
NPI:1558657726
Name:CLARY, ANDREW M (DO)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:M
Last Name:CLARY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:710 COMMERCE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4925
Mailing Address - Country:US
Mailing Address - Phone:651-968-5200
Mailing Address - Fax:651-968-5904
Practice Address - Street 1:2090 WOODWINDS DR STE 200
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2522
Practice Address - Country:US
Practice Address - Phone:651-968-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-25
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN61695207LP2900X
PAOT014163390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine