Provider Demographics
NPI:1790854438
Name:MCCLEERY, GREGORY BRYAN (LSA)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:BRYAN
Last Name:MCCLEERY
Suffix:
Gender:M
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 821382
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76182-1382
Mailing Address - Country:US
Mailing Address - Phone:817-605-0991
Mailing Address - Fax:817-605-0993
Practice Address - Street 1:4401 BOOTH CALLOWAY RD
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-7371
Practice Address - Country:US
Practice Address - Phone:817-605-0991
Practice Address - Fax:817-605-0993
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA0132363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical