Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 5458 | IA |
NPI | 1083644454 |
---|---|
Provider Name | Dr. Larry A Mccray |
First Address | Cedar Rapids, IA 52403-2407 |
Second Address | Cedar Rapids, IA 52403-2407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T00349 | (02) | IA |