Healthcare Provider Details

I. General information

NPI: 1407859689
Provider Name (Legal Business Name): JERRY D MCCREERY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 08/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4879 US HIGHWAY 68 S
WEST LIBERTY OH
43357-9525
US

IV. Provider business mailing address

4879 US HIGHWAY 68 S
WEST LIBERTY OH
43357-9525
US

V. Phone/Fax

Practice location:
  • Phone: 937-599-1411
  • Fax: 937-599-4128
Mailing address:
  • Phone: 937-599-1411
  • Fax: 937-599-4128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35051131M
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: