MEDICARE: JON BRANT MCGREGOR 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	207RC0000X	Cardiovascular Disease Physician	J7580	TX
2	207UN0901X	Nuclear Cardiology Physician	J7580	TX
3	207RC0000X	Cardiovascular Disease Physician	MED-PHYS-LIC-89184	MT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00411171	OTHER	TX	RAILROAD MEDICARE

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

General Provider Information

NPI Number	:	1619925575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JON BRANT MCGREGOR M. D.

Provider Business Mailing Address
First Line	:	PO BOX 12
Second Line	:
City	:	LIBERTY LAKE
State	:	WA
Zip	:	99019-0012
Country	:	US
Telephone Number	:	406-329-5615
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 W BROADWAY ST STE 320
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59802-4003
Country	:	US
Telephone Number	:	406-329-5615
Fax Number	:	406-329-5606

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	11/09/2021

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Directions to “ JON BRANT MCGREGOR M. D.” Practice Location

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