Provider Demographics
NPI:1548253826
Name:MCRAE, ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:MCRAE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 S SAUNDERS ST
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-2321
Mailing Address - Country:US
Mailing Address - Phone:830-249-2600
Mailing Address - Fax:830-249-2635
Practice Address - Street 1:117 S SAUNDERS ST
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2321
Practice Address - Country:US
Practice Address - Phone:830-249-2600
Practice Address - Fax:830-249-2635
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2012-08-30
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-04-19
Provider Licenses
StateLicense IDTaxonomies
TXH5001174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080722401Medicaid
TX113875201Medicaid
TX8589J0Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL NUMBE
TX00518NMedicare ID - Type UnspecifiedMEDICARE FACILITY CODE
TX113875201Medicaid