=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821205956
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DEE MCCRARY JR MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2007
-----------------------------------------------------
Last Update Date | 12/20/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5116 BISSONNET ST
-----------------------------------------------------
City | BELLAIRE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77401
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-349-0248
-----------------------------------------------------
Fax | 713-349-9799
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1888
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-945-2455
-----------------------------------------------------
Fax | 903-453-2541
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. DEE MCCRARY JR.
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 903-454-8111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------