Healthcare Provider Details

I. General information

NPI: 1104153899
Provider Name (Legal Business Name): PATRICK J MCGRATH PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2009
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1947 COMMERCE CENTER CIR STE A
PRESCOTT AZ
86301-4500
US

IV. Provider business mailing address

1947 COMMERCE CENTER CIR STE A
PRESCOTT AZ
86301-4500
US

V. Phone/Fax

Practice location:
  • Phone: 928-458-5723
  • Fax: 928-237-1787
Mailing address:
  • Phone: 928-458-5723
  • Fax: 928-237-1787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7956
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: