Provider Demographics
NPI:1518168962
Name:BOOZER MCCRACKEN, ANN (MD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:BOOZER MCCRACKEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 PEASE ST
Mailing Address - Street 2:SUITE # 204
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8348
Mailing Address - Country:US
Mailing Address - Phone:956-425-4344
Mailing Address - Fax:956-425-4332
Practice Address - Street 1:2121 PEASE ST
Practice Address - Street 2:SUITE # 204
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8348
Practice Address - Country:US
Practice Address - Phone:956-425-4344
Practice Address - Fax:956-425-4332
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL-1132208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00635MMedicare ID - Type Unspecified
TXE33383Medicare UPIN