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General NPI Number Information
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NPI Number | 1649343823
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Entity Type | Individual
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Provider Name | JOHN MACY MD
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Gender | Male
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 12/22/2009
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Provider Practice Location Address
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Address Line | 711 E COLLINS DR
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City | GOLDENDALE
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State | WA
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Zip | 98620-9237
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Country | US
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Telephone | 509-773-4017
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Fax | 509-773-1941
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Provider Business Mailing Address
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Address Line | 310 S ROOSEVELT AVE
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City | GOLDENDALE
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State | WA
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Zip | 98620-9201
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Country | US
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Telephone | 509-773-4022
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Fax | 509-773-1941
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD00016704
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License Number State | WA
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