Provider Demographics
NPI:1609210269
Name:CLEARY, RYAN K (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:K
Last Name:CLEARY
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 1:605 GLENWOOD DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-1130
Mailing Address - Country:US
Mailing Address - Phone:423-495-7739
Mailing Address - Fax:
Practice Address - Street 1:605 GLENWOOD DR STE 200
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404
Practice Address - Country:US
Practice Address - Phone:423-698-1844
Practice Address - Fax:423-624-2226
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TN570472085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ036275Medicaid