Provider Demographics
NPI:1801809124
Name:MCGUIRE, PATRICK CONRAD II (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:CONRAD
Last Name:MCGUIRE
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2101 HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-5340
Mailing Address - Country:US
Mailing Address - Phone:228-497-7576
Mailing Address - Fax:
Practice Address - Street 1:7001 HIGHWAY 614
Practice Address - Street 2:
Practice Address - City:MOSS POINT
Practice Address - State:MS
Practice Address - Zip Code:39562-6483
Practice Address - Country:US
Practice Address - Phone:228-588-6622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22832207R00000X, 208000000X
MS19221208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00121432Medicaid
MSP00394695OtherPALMETTO GBA MEDICARE
MS370000472OtherMEDICARE PTAN
MSP00394695OtherPALMETTO GBA MEDICARE