=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255403929
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RODERICK HECTOR IAN MACGREGOR M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2006
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 998 S DORSET RD
-----------------------------------------------------
City | TROY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45373-4753
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-440-7766
-----------------------------------------------------
Fax | 937-440-8413
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 332 CONGRESS PARK DR
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45459-4133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-312-3627
-----------------------------------------------------
Fax | 937-312-3719
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2083X0100X
-----------------------------------------------------
Taxonomy Name | Occupational Medicine Physician
-----------------------------------------------------
License Number | 35067972
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------