Provider Demographics
NPI:1093706905
Name:MCRAE, WILTON DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:WILTON
Middle Name:DAVID
Last Name:MCRAE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 HIGHWAY 231 S
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36081-3058
Mailing Address - Country:US
Mailing Address - Phone:334-670-5474
Mailing Address - Fax:334-670-5446
Practice Address - Street 1:1320 HIGHWAY 231 S
Practice Address - Street 2:SUITE 3
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36081-3000
Practice Address - Country:US
Practice Address - Phone:334-807-8448
Practice Address - Fax:334-807-6099
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6245207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009962705Medicaid
AL051512237OtherBCBS/ENTERPRISE
AL051552696Medicaid
AL529402450OtherMEDICAID BILLING GROUP #
AL51523327OtherBLUE CROSS BLUE SHIELD #
AL51523327OtherBLUE CROSS BLUE SHIELD #
AL009962705Medicaid
AL051552696Medicare ID - Type UnspecifiedMEDICARE/ENTERPRISE
AL009962705Medicaid