1740361047 NPI number — DUGALD S MACINTYRE MD

Table of content: DUGALD S MACINTYRE MD (NPI 1740361047)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740361047 NPI number — DUGALD S MACINTYRE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACINTYRE
Provider First Name:
DUGALD
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MACINTYRE
Provider Other First Name:
DUGALD
Provider Other Middle Name:
STEWART
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
JR.
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1740361047
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
182 SHORE DR S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33133-2616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-854-4357
Provider Business Mailing Address Fax Number:
305-854-3632

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
182 SHORE DR S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33133-2616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-854-4357
Provider Business Practice Location Address Fax Number:
305-854-3632
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X , with the licence number:  ME0022853 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P 00058509 . This is a "MEDICARE RR" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 055862100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 92233 . This is a "BC/BS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 59274 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 055862100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com