Provider Demographics
NPI:1578983300
Name:MCCLARY, KEEGAN JOHN (MD)
Entity Type:Individual
Prefix:
First Name:KEEGAN
Middle Name:JOHN
Last Name:MCCLARY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 670
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97709-0670
Mailing Address - Country:US
Mailing Address - Phone:541-388-2333
Mailing Address - Fax:541-388-0930
Practice Address - Street 1:1140 SW SIMPSON AVE STE 100
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702
Practice Address - Country:US
Practice Address - Phone:541-388-2333
Practice Address - Fax:541-388-0930
Is Sole Proprietor?:No
Enumeration Date:2014-04-19
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ORMD1869302081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program