Provider Demographics
NPI:1821083544
Name:MCGEE, KRAIG C (MD)
Entity Type:Individual
Prefix:DR
First Name:KRAIG
Middle Name:C
Last Name:MCGEE
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 1:333 N 18TH AVE
Mailing Address - Street 2:# B-3
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-3358
Mailing Address - Country:US
Mailing Address - Phone:208-232-2146
Mailing Address - Fax:208-232-2770
Practice Address - Street 1:333 N 18TH AVE
Practice Address - Street 2:# B-3
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-3358
Practice Address - Country:US
Practice Address - Phone:208-232-2146
Practice Address - Fax:208-232-2770
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM4337207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID73676OtherBLUE CROSS
ID002528200Medicaid
C36893Medicare UPIN
ID002528200Medicaid