Provider Demographics
NPI:1710042064
Name:MCCRARY, MONICA L (MD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:L
Last Name:MCCRARY
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:PO BOX 2156
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-3602
Mailing Address - Country:US
Mailing Address - Phone:830-971-9151
Mailing Address - Fax:830-626-9101
Practice Address - Street 1:120 DIETERT AVE BLDG 300
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2406
Practice Address - Country:US
Practice Address - Phone:830-971-9151
Practice Address - Fax:830-626-9101
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD21678207N00000X
TXJ9523207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000WCYBBMedicare ID - Type Unspecified
G80395Medicare UPIN