Healthcare Provider Details

I. General information

NPI: 1659699007
Provider Name (Legal Business Name): DEE GORDON MCCRARY III DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2010
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 WESLEY ST STE C
GREENVILLE TX
75401-5635
US

IV. Provider business mailing address

8304 INSPIRATION LN
MCKINNEY TX
75071-8599
US

V. Phone/Fax

Practice location:
  • Phone: 903-454-8111
  • Fax: 903-455-8001
Mailing address:
  • Phone: 903-454-8111
  • Fax: 903-455-8001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number2403
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: