Provider Demographics
NPI:1962499590
Name:MCCRORY, DIXIE P (MD)
Entity Type:Individual
Prefix:
First Name:DIXIE
Middle Name:P
Last Name:MCCRORY
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 1:6243 IH 10 WEST
Mailing Address - Street 2:SUITE 480
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-1326
Mailing Address - Country:US
Mailing Address - Phone:210-731-4800
Mailing Address - Fax:210-731-4810
Practice Address - Street 1:8542 WURZBACH ROAD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1241
Practice Address - Country:US
Practice Address - Phone:210-616-7300
Practice Address - Fax:210-616-7359
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3747207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152429001Medicaid
TX152429001Medicaid
H66467Medicare UPIN