Individual
JOHNNY RAY MCCABE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3 E CLARK BASS BLVD, SUITE 2, MCALESTER, OK 74501-4283
(918) 421-6960
(918) 421-6094
Mailing address
1 E CLARK BASS BLVD, MCALESTER, OK 74501-4209
(918) 421-6960
(918) 421-6094
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1244
OK
Other
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
Enumeration date
04/10/2006
Last updated
04/28/2016
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