Basic Information
| Provider Information | |||||||||
| NPI: | 1548229230 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCGREGOR | ||||||||
| FirstName: | MIA | ||||||||
| MiddleName: | MARSHA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1447 MEDICAL PARK BLVD | ||||||||
| Address2: | #402 | ||||||||
| City: | WELLINGTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617902600 | ||||||||
| FaxNumber: | 5617901535 | ||||||||
| Practice Location | |||||||||
| Address1: | 1447 MEDICAL PARK BLVD | ||||||||
| Address2: | #402 | ||||||||
| City: | WELLINGTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617902600 | ||||||||
| FaxNumber: | 5617901535 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2006 | ||||||||
| LastUpdateDate: | 03/24/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | ME78695 | FL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.