Healthcare Provider Details

I. General information

NPI: 1255403929
Provider Name (Legal Business Name): RODERICK HECTOR IAN MACGREGOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

998 S DORSET RD
TROY OH
45373-4753
US

IV. Provider business mailing address

332 CONGRESS PARK DR
DAYTON OH
45459-4133
US

V. Phone/Fax

Practice location:
  • Phone: 937-440-7766
  • Fax: 937-440-8413
Mailing address:
  • Phone: 937-312-3627
  • Fax: 937-312-3719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number35067972
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: