Provider Demographics
NPI:1558545772
Name:JOSEPH M MCCREERY MD PLLC
Entity Type:Organization
Organization Name:JOSEPH M MCCREERY MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCCREERY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-344-2505
Mailing Address - Street 1:PO BOX 21405
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98111-3405
Mailing Address - Country:US
Mailing Address - Phone:206-774-0532
Mailing Address - Fax:
Practice Address - Street 1:4026 NE 55TH ST
Practice Address - Street 2:STE E200
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-2262
Practice Address - Country:US
Practice Address - Phone:206-344-2505
Practice Address - Fax:206-306-0302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000212722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8801184Medicare PIN