MEDICARE: SAM MCCRARY LAT

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	2255A2300X	Athletic Trainer	AT1828	TX

General Provider Information

NPI Number	:	1619410958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAM MCCRARY LAT

Provider Business Mailing Address
First Line	:	808 EVENTIDE DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-5520
Country	:	US
Telephone Number	:	210-427-2920
Fax Number	:

Provider Business Practice Location Address
First Line	:	3233 N SAINT MARYS ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-3579
Country	:	US
Telephone Number	:	210-427-2920
Fax Number	:

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

Provider Enumeration Date	:	11/18/2016
Last Update Date	:	12/17/2025

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