Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | G3959 | TX |
NPI | 1023022365 |
---|---|
Provider Name | Dr. Joseph Dean Mccracken |
First Address | Dallas, TX 75391-1230 |
Second Address | San Antonio, TX 78212-4803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2006 |
Last Update Date | 28/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
123194602 | (05) | TX |
123194606 | (05) | TX |
2121567 | AETNA HMO (01) | TX |
4216632 | AETNA PPO (01) | TX |
830005580 | RAILROAD MEDICARE (01) | TX |
83794J | BLUECROSS/BLUESHIELD TX. (01) | TN |
G19090 | (02) | TX |
P01547659 | RAILROAD MEDICARE (01) | TX |