MEDICARE: DR. GREGORY DON MCCRUM PA-C

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	363A00000X	Physician Assistant	1054552

General Provider Information

NPI Number	:	1528047644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY DON MCCRUM PA-C

Provider Business Mailing Address
First Line	:	29211 SEABISCUIT DR
Second Line	:
City	:	BOERNE
State	:	TX
Zip	:	78015-4416
Country	:	US
Telephone Number	:	253-468-4960
Fax Number	:

Provider Business Practice Location Address
First Line	:	11212 TX HWY 151
Second Line	:	CHRISTUS SANTA ROSA-WESTOVER HILLS
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251
Country	:	US
Telephone Number	:	210-703-8501
Fax Number	:

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

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	10/28/2014

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