Provider Demographics
NPI:1518189810
Name:MICHAEL K MCCRAY MD INC
Entity Type:Organization
Organization Name:MICHAEL K MCCRAY MD INC
Other - Org Name:MCCRAY DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:MCCRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-254-7200
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 RD STE 260
Practice Address - Street 2:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG46675174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA92667Medicare UPIN
CAW13237Medicare ID - Type Unspecified