Individual
R PARKER MCRAE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5405 N KNOXVILLE AVE, PEORIA, IL 61614-5016
(309) 691-4410
Mailing address
5405 N KNOXVILLE AVE, PEORIA, IL 61614-5016
(309) 691-4410
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
036058843
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036058843
—
IL
Enumeration date
07/10/2006
Last updated
11/19/2007
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