Individual
TIMOTHY A MCCREARY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
6822 EAST 1000 SOUTH, FORT DUCHESNE, UT 84026
(435) 725-6874
Mailing address
6822 EAST 1000 SOUTH, FORT DUCHESNE, UT 84026
(435) 725-6874
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
7263849-1206
UT
363AM0700X
Medical Physician Assistant
PA-18491
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
700000000009
—
UT
05
—
806590100
—
ID
05
—
H1232
—
NM
Enumeration date
01/26/2006
Last updated
04/04/2013
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