Provider Demographics
NPI:1942267844
Name:MACKAY, JOHN TAYLOR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:TAYLOR
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 1:2412 W PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5325
Mailing Address - Country:US
Mailing Address - Phone:850-877-8171
Mailing Address - Fax:850-877-9791
Practice Address - Street 1:2412 W PLAZA DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5325
Practice Address - Country:US
Practice Address - Phone:850-877-8171
Practice Address - Fax:850-877-9791
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58246207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE65727Medicare UPIN
FL11596AMedicare PIN