Individual
DR. MARJORIE FROST MCCRACKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD PHD
Contact information
Practice address
2577 SAMARITAN DR, STE 815, SAN JOSE, CA 95124
(408) 358-3573
(408) 356-2888
Mailing address
2577 SAMARITAN DR, STE 815, SAN JOSE, CA 95124
(408) 358-3573
(408) 356-2888
Taxonomy
Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
Primary
G59536
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G565360
—
CA
01
—
770558210
FEDERAL TAX ID
CA
Enumeration date
08/23/2006
Last updated
01/11/2011
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