Healthcare Provider Details

I. General information

NPI: 1295996379
Provider Name (Legal Business Name): OLIVER C. MCCRARY D.O.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2008
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 PASEO DEL PUEBLO NORTE STE C SUITE C
TAOS NM
87571-6316
US

IV. Provider business mailing address

PO BOX 2012
TAOS NM
87571-2012
US

V. Phone/Fax

Practice location:
  • Phone: 575-751-0377
  • Fax:
Mailing address:
  • Phone: 575-751-0377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number110
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: