Healthcare Provider Details

I. General information

NPI: 1821790254
Provider Name (Legal Business Name): JOHN EVERETT MCGANN V DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1846 HIGHWAY 1 STE A
ROCKLEDGE FL
32955-2822
US

IV. Provider business mailing address

3300 S FISKE BLVD
ROCKLEDGE FL
32955-4306
US

V. Phone/Fax

Practice location:
  • Phone: 321-361-5597
  • Fax: 321-434-7035
Mailing address:
  • Phone: 321-361-5597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS23198
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: