Provider Demographics
NPI:1528047644
Name:MCCRUM, GREGORY DON (PA-C)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:DON
Last Name:MCCRUM
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29211 SEABISCUIT DR
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78015-4416
Mailing Address - Country:US
Mailing Address - Phone:253-468-4960
Mailing Address - Fax:
Practice Address - Street 1:11212 TX HWY 151
Practice Address - Street 2:CHRISTUS SANTA ROSA-WESTOVER HILLS
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251
Practice Address - Country:US
Practice Address - Phone:210-703-8501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1054552363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant