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General NPI Number Information
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NPI Number | 1992278584
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Entity Type | Individual
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Provider Name | PHILIP ROGER MACLEOD PA-C
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Gender | Male
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Dates
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Enumeration Date | 01/07/2019
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 2825 CAPITOL AVE
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City | SACRAMENTO
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State | CA
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Zip | 95816-6039
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Country | US
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Telephone | 916-887-1340
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 255228
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City | SACRAMENTO
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State | CA
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Zip | 95865-5228
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Country | US
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Telephone | 800-470-0071
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Fax |
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 022810
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA63106
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License Number State | CA
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