1033321625 NPI number — MR. MARK R MACGREGOR PT

Table of content: MR. MARK R MACGREGOR PT (NPI 1033321625)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033321625 NPI number — MR. MARK R MACGREGOR PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACGREGOR
Provider First Name:
MARK
Provider Middle Name:
R
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033321625
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3010 HUNTERS CREEK BLVD STE 100A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32837-6968
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-601-3922
Provider Business Mailing Address Fax Number:
407-601-3934

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3010 HUNTERS CREEK BLVD
Provider Second Line Business Practice Location Address:
SUITE 100A
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32837-6968
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-601-3922
Provider Business Practice Location Address Fax Number:
407-601-3934
Provider Enumeration Date:
05/04/2007

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: 225100000X , with the licence number:  PT19635 , 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: AK272Z . This is a "MEDICARE IND PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: K7991 . This is a "MEDICARE GROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 006908300 . 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