Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 036064789 | IL |
NPI | 1023025541 |
---|---|
Provider Name | Gary Myles Mccray |
First Address | La Grange Park, IL 60526-1331 |
Second Address | La Grange Park, IL 60526-1331 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 06/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036064789 | (05) | IL |
C37113 | (02) | IL |