Provider Demographics
NPI:1770548505
Name:MACKAY, EDWARD G (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:G
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 1:2863 ALT 19
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-1926
Mailing Address - Country:US
Mailing Address - Phone:727-584-3669
Mailing Address - Fax:727-781-3792
Practice Address - Street 1:2863 ALT 19
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-1926
Practice Address - Country:US
Practice Address - Phone:727-584-3669
Practice Address - Fax:727-781-3792
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME641572086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL18841AMedicare ID - Type Unspecified
FLD45979Medicare UPIN
FLGM983ZMedicare PIN