Provider Demographics
NPI:1659727444
Name:MCFARLAND, MICHAEL PHOENIX (IDC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PHOENIX
Last Name:MCFARLAND
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:898 ENTERPRISE ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32227-1202
Mailing Address - Country:US
Mailing Address - Phone:208-699-6005
Mailing Address - Fax:
Practice Address - Street 1:898 ENTERPRISE ST UNIT A
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32227-1202
Practice Address - Country:US
Practice Address - Phone:208-699-6005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman