Provider Demographics
NPI:1194051482
Name:MCCRAY, LEROY DEVON (IDC)
Entity type:Individual
Prefix:
First Name:LEROY
Middle Name:DEVON
Last Name:MCCRAY
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 567 BOX 6632
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96384-6632
Mailing Address - Country:US
Mailing Address - Phone:310-633-4960
Mailing Address - Fax:
Practice Address - Street 1:PSC 567 BOX 6632
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96384-6632
Practice Address - Country:US
Practice Address - Phone:310-633-4960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman