Provider Demographics
NPI:1144390006
Name:MCRAE, SCOTT VICTOR (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:VICTOR
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 1:300 SAN GABRIEL VILLAGE BLVD
Mailing Address - Street 2:#420
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-6689
Mailing Address - Country:US
Mailing Address - Phone:254-288-8090
Mailing Address - Fax:
Practice Address - Street 1:2301 HOUSE AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3176
Practice Address - Country:US
Practice Address - Phone:307-635-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY9262A207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology