Provider Demographics
NPI:1952325466
Name:MACRAE, DAVID HASKINS (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:HASKINS
Last Name:MACRAE
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 1:610 PROVIDENCE PARK DR E STE 101
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-4618
Mailing Address - Country:US
Mailing Address - Phone:251-378-3900
Mailing Address - Fax:251-378-3902
Practice Address - Street 1:610 PROVIDENCE PARK DR E STE 101
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695
Practice Address - Country:US
Practice Address - Phone:251-378-3900
Practice Address - Fax:251-378-3902
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.11594207RG0300X
AL00011594207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0410744OtherUNITED HEALTHCARE
AL000093298Medicaid
AL5099060OtherAETNA
AL110219671OtherRAILROAD MEDICARE
AL51093298OtherBCBS OF AL
AL000093298Medicare ID - Type Unspecified
AL0410744OtherUNITED HEALTHCARE