MEDICARE: ROBERT O. MCRAE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	208000000X	Pediatrics Physician	14215839-1205	UT

General Provider Information

NPI Number	:	1841753308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT O. MCRAE MD

Provider Business Mailing Address
First Line	:	81 S MARIO CAPECCHI DR RM 4E207
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84112-5888
Country	:	US
Telephone Number	:	801-581-2121
Fax Number	:

Provider Business Practice Location Address
First Line	:	81 S MARIO CAPECCHI DR RM 4E207
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84112-5888
Country	:	US
Telephone Number	:	801-581-2121
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2019
Last Update Date	:	04/08/2025

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