Healthcare Provider Details

I. General information

NPI: 1154926079
Provider Name (Legal Business Name): ALEXANDER PHILLIP MCLAREN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6919 N DALE MABRY HWY STE 325
TAMPA FL
33614-3860
US

IV. Provider business mailing address

9847 MONTAGUE ST
WESTCHASE FL
33626-1863
US

V. Phone/Fax

Practice location:
  • Phone: 800-531-1587
  • Fax:
Mailing address:
  • Phone: 248-431-1406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9113705
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: