Provider Demographics
NPI:1093018301
Name:MCGOOHAN, JOHN J IV (DO,)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:MCGOOHAN
Suffix:IV
Gender:M
Credentials:DO,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 S FEDERAL HWY STE 403
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-6811
Mailing Address - Country:US
Mailing Address - Phone:954-929-3449
Mailing Address - Fax:954-929-2001
Practice Address - Street 1:210 S FEDERAL HWY STE 403
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-6811
Practice Address - Country:US
Practice Address - Phone:954-929-3449
Practice Address - Fax:954-929-2001
Is Sole Proprietor?:No
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5525208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice