MEDICARE: MR. ALEXANDER PHILLIP MCLAREN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	9113705	FL

General Provider Information

NPI Number	:	1154926079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALEXANDER PHILLIP MCLAREN PA-C

Provider Business Mailing Address
First Line	:	9847 MONTAGUE ST
Second Line	:
City	:	WESTCHASE
State	:	FL
Zip	:	33626-1863
Country	:	US
Telephone Number	:	248-431-1406
Fax Number	:

Provider Business Practice Location Address
First Line	:	6919 N DALE MABRY HWY STE 325
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-3860
Country	:	US
Telephone Number	:	800-531-1587
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2020
Last Update Date	:	11/30/2020

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Directions to “ MR. ALEXANDER PHILLIP MCLAREN PA-C” Practice Location

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