Provider Demographics
NPI:1700872876
Name:MACGREGOR, PAUL S (DO)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:S
Last Name:MACGREGOR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 S CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-2926
Mailing Address - Country:US
Mailing Address - Phone:641-422-6700
Mailing Address - Fax:641-422-6679
Practice Address - Street 1:250 S CRESCENT DR
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-2926
Practice Address - Country:US
Practice Address - Phone:641-422-6700
Practice Address - Fax:641-422-6679
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2086208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0228916Medicaid
IA20484Medicare ID - Type Unspecified
IA0355010044Medicare NSC
IAA14525Medicare UPIN