Provider Demographics
NPI:1407895717
Name:MCCREADY, HARLEY CLINT (MD)
Entity Type:Individual
Prefix:MR
First Name:HARLEY
Middle Name:CLINT
Last Name:MCCREADY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 HARN ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201
Mailing Address - Country:US
Mailing Address - Phone:318-509-9407
Mailing Address - Fax:318-325-3724
Practice Address - Street 1:4310 SOUTH GRAND
Practice Address - Street 2:
Practice Address - City:MUNROE
Practice Address - State:LA
Practice Address - Zip Code:71201
Practice Address - Country:US
Practice Address - Phone:318-812-1000
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020260208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1900095Medicaid
LA1900095Medicaid
5N077Medicare ID - Type Unspecified