MEDICARE: DR. MICHAEL G MACON M.D.

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	208600000X	Surgery Physician	D0030763	MD
2	208600000X	Surgery Physician	53388	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174526222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL G MACON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 10880
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86304-0880
Country	:	US
Telephone Number	:	928-759-5874
Fax Number	:	928-458-2039

Provider Business Practice Location Address
First Line	:	7700 E FLORENTINE RD
Second Line	:	BLDG B, STE 203
City	:	PRESCOTT VALLEY
State	:	AZ
Zip	:	86314-2245
Country	:	US
Telephone Number	:	928-442-8740
Fax Number	:	928-442-8142

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	02/21/2017

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Directions to “ DR. MICHAEL G MACON M.D.” Practice Location

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