Basic Information
| Provider Information | |||||||||
| NPI: | 1467405233 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAIN | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | TERRILL | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2405 SE 17TH ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344719190 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3526902171 | ||||||||
| FaxNumber: | 3526906954 | ||||||||
| Practice Location | |||||||||
| Address1: | 1725 SE 28TH LOOP STE 102 | ||||||||
| Address2: | |||||||||
| City: | OCALA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 344715328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3526291743 | ||||||||
| FaxNumber: | 3526291748 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 09/11/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 4163 | OK | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | OS14853 | FL | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.