Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | N8123 | TX |
N | 207PP0204X | Pediatric Emergency Physician | N8123 | TX |
N | 208000000X | Pediatrician | N8123 | TX |
NPI | 1215131115 |
---|---|
Provider Name | Dr. Reagann Richards Mccreary |
First Address | Fort Worth, TX 76107-2054 |
Second Address | Dallas, TX 75235-7701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2007 |
Last Update Date | 21/09/2011 |