MEDICARE: DR. JON P MCCREARY DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	218	AR
2	213ES0103X	Foot & Ankle Surgery Podiatrist	1644	TX

General Provider Information

NPI Number	:	1225030802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JON P MCCREARY DPM

Provider Business Mailing Address
First Line	:	PO BOX 92096
Second Line	:
City	:	SOUTHLAKE
State	:	TX
Zip	:	76092-0101
Country	:	US
Telephone Number	:	817-731-4279
Fax Number	:	817-731-0693

Provider Business Practice Location Address
First Line	:	3221 HULEN ST STE A
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6186
Country	:	US
Telephone Number	:	817-731-4279
Fax Number	:

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	10/29/2019

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