Healthcare Provider Details

I. General information

NPI: 1689774630
Provider Name (Legal Business Name): JOHN ROBERT MCCREARY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 06/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1383 E HERNDON AVE SUITE 105
FRESNO CA
93720-3302
US

IV. Provider business mailing address

1383 E HERNDON AVE SUITE 105
FRESNO CA
93720-3302
US

V. Phone/Fax

Practice location:
  • Phone: 559-233-4691
  • Fax:
Mailing address:
  • Phone: 559-233-4691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberC29075
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: