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General NPI Number Information
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NPI Number | 1932215753
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Entity Type | Individual
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Provider Name | IAN N RAE M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 02/08/2021
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Provider Practice Location Address
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Address Line | 99189 OVERSEAS HIGHWAY SUITE #2
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City | KEY LARGO
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State | FL
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Zip | 33037-3303
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Country | US
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Telephone | 305-453-3006
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Fax | 305-453-3310
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Provider Business Mailing Address
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Address Line | PO BOX 998
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City | TAVERNIER
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State | FL
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Zip | 33070-0998
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Country | US
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Telephone | 305-453-3006
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Fax | 305-453-3310
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME0003371
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License Number State | FL
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