Provider Demographics
NPI:1942203278
Name:MCCRARY, DEE G JR (MD)
Entity Type:Individual
Prefix:
First Name:DEE
Middle Name:G
Last Name:MCCRARY
Suffix:JR
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 1:4101 WESLEY ST STE C
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-5635
Mailing Address - Country:US
Mailing Address - Phone:903-454-8111
Mailing Address - Fax:903-454-1680
Practice Address - Street 1:4101 WESLEY ST
Practice Address - Street 2:STE C
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-5635
Practice Address - Country:US
Practice Address - Phone:903-454-8111
Practice Address - Fax:903-454-1680
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4513207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133516809Medicaid
TX00332VOtherMEDICARE GROUP #
TX8J1200OtherBCBS OF TEXAS
TX80166325OtherRAILROAD MEDICARE
TX133516812Medicaid
TX8J1200OtherBCBS OF TEXAS
TX133516811Medicaid
TX8J1200OtherBCBS OF TEXAS
TX8L26487Medicare PIN
TX8L26489Medicare PIN
TX00332VOtherMEDICARE GROUP #