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NPI Code Detail

MEDICARE: BOGAN M. MCQUIGG, III PA

MEDICARE: BOGAN M. MCQUIGG, III PA
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
1363A00000XPhysician AssistantPA9102278FL

General Provider Information

NPI Number : 1437100435
Entity Type Code : Individual
Provider Name (Legal Business Name) : BOGAN M. MCQUIGG, III PA
Provider Business Mailing Address
First Line : 200 CORPORATE BLVD
Second Line : SUITE 200
City : LAFAYETTE
State : LA
Zip : 70508-3870
Country : US
Telephone Number : 800-893-9698
Fax Number :
Provider Business Practice Location Address
First Line : 151 E REDSTONE AVE
Second Line :
City : CRESTVIEW
State : FL
Zip : 32539-5352
Country : US
Telephone Number : 850-936-1617
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2006
Last Update Date : 04/09/2008

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