Provider Demographics
NPI:1477564391
Name:MCCAIN, ELEANOR A (MD)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:A
Last Name:MCCAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 MEIGS DR
Mailing Address - Street 2:
Mailing Address - City:SHALIMAR
Mailing Address - State:FL
Mailing Address - Zip Code:32579
Mailing Address - Country:US
Mailing Address - Phone:850-651-8886
Mailing Address - Fax:850-864-3817
Practice Address - Street 1:918 MARWALT DR
Practice Address - Street 2:
Practice Address - City:FT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547
Practice Address - Country:US
Practice Address - Phone:850-863-8812
Practice Address - Fax:850-864-3817
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044529207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL47172ZMedicare PIN
D32847Medicare UPIN