Basic Information
| Provider Information | |||||||||
| NPI: | 1972597490 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCRARY | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | FOUNTAIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 11773 | ||||||||
| Address2: | |||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852480013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4809077707 | ||||||||
| FaxNumber: | 4809077097 | ||||||||
| Practice Location | |||||||||
| Address1: | 1012 E WILLETTA ST | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850062749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6028396040 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2005 | ||||||||
| LastUpdateDate: | 11/04/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083A0100X | K4950 | TX | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Aerospace Medicine | 2083A0100X | 4328 | SD | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Aerospace Medicine | 2083P0011X | 2191 | IA | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Undersea and Hyperbaric Medicine | 2083X0100X | 2269 | AZ | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine | 2083X0100X | 29397 | CO | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine | 2083X0100X | A-884-89 | NM | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine | 2083X0100X | 836 | NV | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine | 2083X0100X | 6289 | WY | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine | 2083P0011X | 2269 | AZ | Y | Allopathic & Osteopathic Physicians | Preventive Medicine | Undersea and Hyperbaric Medicine | 2083A0100X | 2269 | AZ | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Aerospace Medicine |
No ID Information.