Provider Demographics
NPI:1720127715
Name:MCRAE, BRENDEN (MD)
Entity type:Individual
Prefix:
First Name:BRENDEN
Middle Name:
Last Name:MCRAE
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 1:888 S GREENFIELD RD #102
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-4012
Mailing Address - Country:US
Mailing Address - Phone:480-507-0700
Mailing Address - Fax:480-507-7477
Practice Address - Street 1:888 S GREENFIELD RD STE 102
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-4012
Practice Address - Country:US
Practice Address - Phone:480-507-0700
Practice Address - Fax:480-269-9090
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37188207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ235400Medicaid
AZZ139656Medicare PIN
AZZ140884Medicare PIN