Provider Demographics
NPI:1932473089
Name:MCCRAY, DEVINA KOMALAWATI SIREGAR (MD)
Entity Type:Individual
Prefix:
First Name:DEVINA
Middle Name:KOMALAWATI SIREGAR
Last Name:MCCRAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:661 E ALTAMONTE DR STE 231
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-5102
Mailing Address - Country:US
Mailing Address - Phone:407-303-5214
Mailing Address - Fax:407-303-5215
Practice Address - Street 1:661 E ALTAMONTE DR STE 231
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-5102
Practice Address - Country:US
Practice Address - Phone:407-303-5214
Practice Address - Fax:407-303-5215
Is Sole Proprietor?:No
Enumeration Date:2012-03-06
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA121268208600000X
OH35.126197208600000X
VA0101260265208600000X
FLME107029208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery