Provider Demographics
NPI:1346277613
Name:MACKAY, GREGORY DAVIS (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:DAVIS
Last Name:MACKAY
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 1:3450 11TH CT STE 206
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-5012
Mailing Address - Country:US
Mailing Address - Phone:772-299-3511
Mailing Address - Fax:772-299-3517
Practice Address - Street 1:3745 11TH CIR
Practice Address - Street 2:SUITE 101
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4837
Practice Address - Country:US
Practice Address - Phone:772-299-3211
Practice Address - Fax:772-299-3517
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 60347207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12603OtherBLUE CROSS
FLO55359000Medicaid
FL100015007OtherRR MEDICARE
FLO55359000Medicaid
FL12603WMedicare ID - Type Unspecified