Provider Demographics
NPI:1205087889
Name:MCCREA, JOHN DAVID (DPM)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DAVID
Last Name:MCCREA
Suffix:
Gender:M
Credentials:DPM
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 783
Mailing Address - Street 2:
Mailing Address - City:WOODRUFF
Mailing Address - State:WI
Mailing Address - Zip Code:54568-0783
Mailing Address - Country:US
Mailing Address - Phone:941-916-0319
Mailing Address - Fax:
Practice Address - Street 1:2285 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:LAC DU FLAMBEAU
Practice Address - State:WI
Practice Address - Zip Code:54538-9349
Practice Address - Country:US
Practice Address - Phone:941-916-0319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI402213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery