Healthcare Provider Details

I. General information

NPI: 1093165912
Provider Name (Legal Business Name): JAMES DONALD MCGREGOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 6489 180 W. FIRST STREET SUITE 302
KETCHUM ID
83340
US

IV. Provider business mailing address

PO BOX 6489 180 W. FIRST STREET SUITE 302
KETCHUM ID
83340
US

V. Phone/Fax

Practice location:
  • Phone: 208-726-5996
  • Fax: 208-725-0065
Mailing address:
  • Phone: 208-726-5996
  • Fax: 208-725-0065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11019014A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberM-15278
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: