Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | ME87612 | FL |
Y | 208D00000X | General Practice Physician | ME87612 | FL |
NPI | 1033160247 |
---|---|
Provider Name | Chad E. Mcrae |
First Address | Rockland, DE 19732-0191 |
Second Address | Orlando, FL 32819-7217 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 26/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
267341000 | (05) | FL |
3240346 | AETNA PROVIDER # (01) | FL |
5688069 | CIGNA PROVIDER # (01) | FL |
71408 | BCBS PROVIDER # (01) | FL |