Healthcare Provider Details

I. General information

NPI: 1598938896
Provider Name (Legal Business Name): DALLAS MCKAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 SW 2ND AVE AYERS SOUTH #204
GAINESVILLE FL
32601-6271
US

IV. Provider business mailing address

720 SW 2ND AVE AYERS SOUTH #204
GAINESVILLE FL
32601-6271
US

V. Phone/Fax

Practice location:
  • Phone: 352-733-0246
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number61022240
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: