Healthcare Provider Details

I. General information

NPI: 1841753308
Provider Name (Legal Business Name): ROBERT O. MCRAE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2019
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 S MARIO CAPECCHI DR RM 4E207
SALT LAKE CITY UT
84112-5888
US

IV. Provider business mailing address

81 S MARIO CAPECCHI DR RM 4E207
SALT LAKE CITY UT
84112-5888
US

V. Phone/Fax

Practice location:
  • Phone: 801-581-2121
  • Fax:
Mailing address:
  • Phone: 801-581-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number14215839-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberMD.MD.61268628
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: