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General NPI Number Information
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NPI Number | 1487039723
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Entity Type | Organization
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Legal Business Name | MCGREGOR MEDICAL AND WELLNESS,LLC
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Dates
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Enumeration Date | 07/28/2015
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Last Update Date | 07/28/2015
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Provider Practice Location Address
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Address Line | 16731 MCGREGOR BLVD STE 105
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City | FORT MYERS
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State | FL
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Zip | 33908-3876
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Country | US
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Telephone | 276-336-0842
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Fax |
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Provider Business Mailing Address
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Address Line | 581 OCEANSIDE BLVD
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City | INDIALANTIC
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State | FL
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Zip | 32903-1835
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Country | US
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Telephone | 276-336-0842
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MAY JOY DAVID LIM
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Credential | M.D.
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Telephone | 276-336-0842
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ME110139
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License Number State | FL
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