Provider Demographics
NPI:1649251166
Name:MACGREGOR, JOHN T (PA-C)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:MACGREGOR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-868-7222
Mailing Address - Fax:321-951-7408
Practice Address - Street 1:220 N SYKES CREEK PKWY STE 301
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-3490
Practice Address - Country:US
Practice Address - Phone:321-868-7222
Practice Address - Fax:321-361-5543
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLID610ZOtherMEDICARE
FLID610ZOtherMEDICARE