Basic Information
| Provider Information | |||||||||
| NPI: | 1467879346 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MACRAE | ||||||||
| FirstName: | ERIC | ||||||||
| MiddleName: | RUSSELL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 208 SOUTHSHORE DR | ||||||||
| Address2: | |||||||||
| City: | LAKE WINNEBAGO | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640349471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8165175489 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3901 RAINBOW BLVD | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 661608500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9135885000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2014 | ||||||||
| LastUpdateDate: | 08/08/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 2017012009 | MO | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.