MEDICARE: DR. JIM R. MCCRARY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	10430	TX

General Provider Information

NPI Number	:	1134271372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JIM R. MCCRARY DDS

Provider Business Mailing Address
First Line	:	6111 FM 1960 RD W
Second Line	:	SUITE 207
City	:	HOUSTON
State	:	TX
Zip	:	77069-4112
Country	:	US
Telephone Number	:	281-440-1050
Fax Number	:

Provider Business Practice Location Address
First Line	:	6111 FM 1960 RD W
Second Line	:	SUITE 207
City	:	HOUSTON
State	:	TX
Zip	:	77069-4112
Country	:	US
Telephone Number	:	281-440-1050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	07/08/2007

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