Provider Demographics
NPI:1467405233
Name:MAIN, JOHN TERRILL (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:TERRILL
Last Name:MAIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2405 SE 17TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-9190
Mailing Address - Country:US
Mailing Address - Phone:352-690-2171
Mailing Address - Fax:352-690-6954
Practice Address - Street 1:1725 SE 28TH LOOP STE 102
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5328
Practice Address - Country:US
Practice Address - Phone:352-629-1743
Practice Address - Fax:352-629-1748
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK4163207T00000X
FLOS14853207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK243629703Medicare PIN
I07803Medicare UPIN
OK300522253Medicare PIN