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General NPI Number Information
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NPI Number | 1093706905
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Entity Type | Individual
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Provider Name | WILTON DAVID MCRAE MD
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Gender | Male
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Dates
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Enumeration Date | 10/31/2005
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Last Update Date | 04/03/2017
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Provider Practice Location Address
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Address Line | 1320 HIGHWAY 231 S SUITE 3
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City | TROY
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State | AL
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Zip | 36081-3000
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Country | US
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Telephone | 334-807-8448
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Fax | 334-807-6099
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Provider Business Mailing Address
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Address Line | 1330 HIGHWAY 231 S
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City | TROY
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State | AL
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Zip | 36081-3058
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Country | US
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Telephone | 334-670-5474
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Fax | 334-670-5446
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 6245
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License Number State | AL
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