Provider Demographics
NPI:1235282856
Name:MCCRAY, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:MCCRAY
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 1:27420 TOURNEY ROAD
Mailing Address - Street 2:260
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-5636
Mailing Address - Country:US
Mailing Address - Phone:661-254-7200
Mailing Address - Fax:661-254-8204
Practice Address - Street 1:27420 TOURNEY ROAD
Practice Address - Street 2:260
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5636
Practice Address - Country:US
Practice Address - Phone:661-254-7200
Practice Address - Fax:661-254-8204
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG46675207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW13237Medicare ID - Type Unspecified
CAW17939Medicare UPIN