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General NPI Number Information
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NPI Number | 1982269643
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Entity Type | Individual
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Provider Name | ROBERT MICHAEL MACBAIN
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Gender | Male
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Dates
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Enumeration Date | 05/07/2019
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Last Update Date | 03/12/2021
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Provider Practice Location Address
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Address Line | 7403 PURSER LN
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City | HANAHAN
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State | SC
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Zip | 29410-8291
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Country | US
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Telephone | 843-330-8194
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Fax |
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Provider Business Mailing Address
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Address Line | 11945 SAN JOSE BLVD STE 300
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City | JACKSONVILLE
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State | FL
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Zip | 32223-1627
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Country | US
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Telephone | 904-396-1725
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Fax | 904-396-4893
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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