Basic Information
| Provider Information | |||||||||
| NPI: | 1952325466 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MACRAE | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | HASKINS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 610 PROVIDENCE PARK DR E STE 101 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366954618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2513783900 | ||||||||
| FaxNumber: | 2513783902 | ||||||||
| Practice Location | |||||||||
| Address1: | 610 PROVIDENCE PARK DR E STE 101 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 36695 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2513783900 | ||||||||
| FaxNumber: | 2513783902 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 02/06/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | MD.11594 | AL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 207R00000X | 00011594 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0410744 | 01 | AL | UNITED HEALTHCARE | OTHER | 000093298 | 05 | AL | MEDICAID | 5099060 | 01 | AL | AETNA | OTHER | 110219671 | 01 | AL | RAILROAD MEDICARE | OTHER | 51093298 | 01 | AL | BCBS OF AL | OTHER |