=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225099583
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GARY C MCCARRAGHER M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2006
-----------------------------------------------------
Last Update Date | 09/01/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12190 CORTEZ BLVD
-----------------------------------------------------
City | BROOKSVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34613-5578
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-597-1206
-----------------------------------------------------
Fax | 352-597-1208
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12190 CORTEZ BLVD
-----------------------------------------------------
City | BROOKSVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34613-5578
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-597-1206
-----------------------------------------------------
Fax | 352-597-1208
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RH0002X
-----------------------------------------------------
Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | ME64668
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------