Provider Demographics
NPI:1881812402
Name:MCCRAE, DEREK L (MD)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:L
Last Name:MCCRAE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2880 ATLANTIC AVE
Mailing Address - Street 2:SUITE 170
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1714
Mailing Address - Country:US
Mailing Address - Phone:562-492-9900
Mailing Address - Fax:562-492-9902
Practice Address - Street 1:2880 ATLANTIC AVE
Practice Address - Street 2:SUITE 170
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1714
Practice Address - Country:US
Practice Address - Phone:562-492-9900
Practice Address - Fax:562-492-9902
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2013-12-13
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Provider Licenses
StateLicense IDTaxonomies
CAA696562080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA69656OtherSTATE LICENSE
CA1043640063OtherCARDIN HEALTHCARE