Provider Demographics
NPI:1235162447
Name:MACGREGOR, DAVID JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JAMES
Last Name:MACGREGOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 SUTTER ST RM 1824
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-4111
Mailing Address - Country:US
Mailing Address - Phone:415-989-9400
Mailing Address - Fax:415-788-8004
Practice Address - Street 1:450 SUTTER ST RM 1824
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-4111
Practice Address - Country:US
Practice Address - Phone:415-989-9400
Practice Address - Fax:415-788-8004
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70045207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACGP161587Medicaid
008700451Medicare ID - Type Unspecified
CAH50430Medicare UPIN