Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 328127 | LA |
N | 207QS0010X | Family Doctor - Sports Medicine | 328127 | LA |
NPI | 1003227612 |
---|---|
Provider Name | Dr. Maxwell Gilbert Mccray JR. |
First Address | Ponchatoula, LA 70454-4113 |
Second Address | Baton Rouge, LA 70806-3743 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2014 |
Last Update Date | 06/02/2022 |