Provider Demographics
NPI:1396989745
Name:MCCLEARY, EDWARD LARRY (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:LARRY
Last Name:MCCLEARY
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 1:481 ALPINE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:INCLINE VILLAGE
Mailing Address - State:NV
Mailing Address - Zip Code:89451-8916
Mailing Address - Country:US
Mailing Address - Phone:720-840-6528
Mailing Address - Fax:
Practice Address - Street 1:481 ALPINE VIEW DR
Practice Address - Street 2:
Practice Address - City:INCLINE VILLAGE
Practice Address - State:NV
Practice Address - Zip Code:89451-8916
Practice Address - Country:US
Practice Address - Phone:720-840-6528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO27292207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery