MEDICARE: JOHN T MACGREGOR PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ID610Z	OTHER	FL	MEDICARE

General Provider Information

NPI Number	:	1649251166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN T MACGREGOR PA-C

Provider Business Mailing Address
First Line	:	3300 S FISKE BLVD
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-4306
Country	:	US
Telephone Number	:	321-868-7222
Fax Number	:	321-951-7408

Provider Business Practice Location Address
First Line	:	220 N SYKES CREEK PKWY STE 301
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-3490
Country	:	US
Telephone Number	:	321-868-7222
Fax Number	:	321-361-5543

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	01/22/2020

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Directions to “ JOHN T MACGREGOR PA-C” Practice Location

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