# JOHNNY RAY MCCABE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1912960196
- **Gender:** Man
- **Credential:** PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 1244 | OK | Yes |

## Other

- **Enumeration date:** 04/10/2006
- **Last updated:** 04/28/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1324230001 | PALMETTO DME | OK |
| 05 | — | 200005680B | — | OK |
| 01 | — | 200005680C | SOONER PCP | OK |
| 01 | — | J MCCABE PA | STERLING OPTION 1 | OK |
| 01 | — | P00090959 | RR MEDICARE (PALMETTO) | OK |