Basic Information
| Provider Information | |||||||||
| NPI: | 1215131115 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCREARY | ||||||||
| FirstName: | REAGANN | ||||||||
| MiddleName: | RICHARDS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3770 W 4TH ST | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761072054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8178860701 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1935 MEDICAL DISTRICT DR | ||||||||
| Address2: | MC E2.03 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752357701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2144566371 | ||||||||
| FaxNumber: | 2144568132 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2007 | ||||||||
| LastUpdateDate: | 09/21/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | N8123 | TX | N | Allopathic & Osteopathic Physicians | Pediatrics | 207P00000X | N8123 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207PP0204X | N8123 | TX | N | Allopathic & Osteopathic Physicians | Emergency Medicine | Pediatric Emergency Medicine |
No ID Information.