Healthcare Provider Details

I. General information

NPI: 1720127715
Provider Name (Legal Business Name): BRENDEN MCRAE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 08/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 S GREENFIELD RD STE 102
GILBERT AZ
85296-4012
US

IV. Provider business mailing address

888 S GREENFIELD RD #102
GILBERT AZ
85296-4012
US

V. Phone/Fax

Practice location:
  • Phone: 480-507-0700
  • Fax: 480-269-9090
Mailing address:
  • Phone: 480-507-0700
  • Fax: 480-507-7477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number37188
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: