Provider Demographics
NPI:1225030802
Name:MCCREARY, JON P (DPM)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:P
Last Name:MCCREARY
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 92096
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-0101
Mailing Address - Country:US
Mailing Address - Phone:817-731-4279
Mailing Address - Fax:817-731-0693
Practice Address - Street 1:3221 HULEN ST STE A
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-6186
Practice Address - Country:US
Practice Address - Phone:817-731-4279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR218213ES0103X
TX1644213ES0103X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB126763Medicare PIN
U97257Medicare UPIN
TX00576UMedicare PIN