Provider Demographics
NPI:1124069968
Name:MCCLEARY, THOMAS G (DO)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:G
Last Name:MCCLEARY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3200 N WINDSONG DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-2255
Mailing Address - Country:US
Mailing Address - Phone:928-772-1505
Mailing Address - Fax:928-772-6343
Practice Address - Street 1:3200 N WINDSONG DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2255
Practice Address - Country:US
Practice Address - Phone:928-772-1505
Practice Address - Fax:928-772-6343
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ005476207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
116913561OtherRAILROAD MEDICARE
E43493Medicare UPIN