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General NPI Number Information
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NPI Number | 1770548505
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Entity Type | Individual
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Provider Name | EDWARD G. MACKAY M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/17/2006
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Last Update Date | 10/31/2019
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Provider Practice Location Address
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Address Line | 2863 ALT 19
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City | PALM HARBOR
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State | FL
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Zip | 34683-1926
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Country | US
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Telephone | 727-584-3669
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Fax | 727-781-3792
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Provider Business Mailing Address
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Address Line | 2863 ALT 19
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City | PALM HARBOR
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State | FL
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Zip | 34683-1926
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Country | US
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Telephone | 727-584-3669
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Fax | 727-781-3792
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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 | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | ME64157
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License Number State | FL
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