MEDICARE: MR. HARLEY CLINT MCCREADY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	020260	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407895717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HARLEY CLINT MCCREADY MD

Provider Business Mailing Address
First Line	:	410 HARN ST
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71201
Country	:	US
Telephone Number	:	318-509-9407
Fax Number	:	318-325-3724

Provider Business Practice Location Address
First Line	:	4310 SOUTH GRAND
Second Line	:
City	:	MUNROE
State	:	LA
Zip	:	71201
Country	:	US
Telephone Number	:	318-812-1000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	07/08/2007

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Directions to “ MR. HARLEY CLINT MCCREADY MD” Practice Location

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