Provider Demographics
NPI:1639172075
Name:CLARY, ROBERT A (DO P C)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:CLARY
Suffix:
Gender:M
Credentials:DO P C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:MT
Mailing Address - Zip Code:59474-1906
Mailing Address - Country:US
Mailing Address - Phone:406-424-8800
Mailing Address - Fax:406-424-8866
Practice Address - Street 1:100 MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:MT
Practice Address - Zip Code:59474-1906
Practice Address - Country:US
Practice Address - Phone:406-424-8800
Practice Address - Fax:406-424-8866
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4819207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT4819OtherSTATE LICENSE
MT4819OtherSTATE LICENSE
010000385Medicare PIN