Provider Demographics
NPI:1497071047
Name:MCGETRICK, JOHN J JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:MCGETRICK
Suffix:JR
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 1:810 N ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4944
Mailing Address - Country:US
Mailing Address - Phone:407-943-7100
Mailing Address - Fax:407-943-7328
Practice Address - Street 1:810 N ROSE AVE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4944
Practice Address - Country:US
Practice Address - Phone:407-943-7100
Practice Address - Fax:407-943-7328
Is Sole Proprietor?:No
Enumeration Date:2010-04-07
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME124033208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIF199ZMedicare PIN
FLIF199YMedicare PIN