Provider Demographics
NPI:1932215753
Name:RAE, IAN N (MD)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:N
Last Name:RAE
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:PO BOX 998
Mailing Address - Street 2:
Mailing Address - City:TAVERNIER
Mailing Address - State:FL
Mailing Address - Zip Code:33070-0998
Mailing Address - Country:US
Mailing Address - Phone:305-453-3006
Mailing Address - Fax:305-453-3310
Practice Address - Street 1:99189 OVERSEAS HIGHWAY
Practice Address - Street 2:SUITE #2
Practice Address - City:KEY LARGO
Practice Address - State:FL
Practice Address - Zip Code:33037-3303
Practice Address - Country:US
Practice Address - Phone:305-453-3006
Practice Address - Fax:305-453-3310
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0003371207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370516100Medicaid
FL370516101Medicaid
FL930106664OtherRAILROAD MEDICARE
FL95144OtherBLUE CROSS BLUE SHIELD
FL930106664OtherRAILROAD MEDICARE
FL95144OtherBLUE CROSS BLUE SHIELD
FLE15843Medicare UPIN
FLK2625Medicare ID - Type UnspecifiedMEDICARE GROUP ID NUMBER
FL95144ZMedicare ID - Type Unspecified