Provider Demographics
NPI:1326263310
Name:LOTT, MCGREGOR NORMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MCGREGOR
Middle Name:NORMAN
Last Name:LOTT
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 1:11945 SAN JOSE BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-1627
Mailing Address - Country:US
Mailing Address - Phone:904-396-1725
Mailing Address - Fax:
Practice Address - Street 1:11512 LAKE MEAD AVE UNIT 534
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-5835
Practice Address - Country:US
Practice Address - Phone:904-564-2020
Practice Address - Fax:904-518-3297
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME131445207W00000X
GA061121207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15683OtherBCBS-FL
FLAG347VOtherMEDICARE
GA898748800AMedicaid