=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730438730
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EDWARD G MACKAY MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/05/2012
-----------------------------------------------------
Last Update Date | 10/15/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2863 ALT 19
-----------------------------------------------------
City | PALM HARBOR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34683-1926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-781-5652
-----------------------------------------------------
Fax | 727-781-3792
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2863 ALT 19
-----------------------------------------------------
City | PALM HARBOR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34683-1926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-781-5652
-----------------------------------------------------
Fax | 727-781-3792
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/OFFICER
-----------------------------------------------------
Name | EDWARD G MACKAY
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 727-781-5652
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2086S0129X
-----------------------------------------------------
Taxonomy Name | Vascular Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------