Healthcare Provider Details

I. General information

NPI: 1285602995
Provider Name (Legal Business Name): JOSEPH STUART MCCRACKEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 09/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2609 N DUKE ST #620
DURHAM NC
27704
US

IV. Provider business mailing address

2609 N DUKE ST #620
DURHAM NC
27704
US

V. Phone/Fax

Practice location:
  • Phone: 919-220-5439
  • Fax: 919-220-8102
Mailing address:
  • Phone: 919-220-5439
  • Fax: 919-220-8102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number22310
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: