Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 11019014A | IN |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | M-15278 | ID |
NPI | 1093165912 |
---|---|
Provider Name | Dr. James Donald Mcgregor |
First Address | Meridian, ID 83642 |
Second Address | Eagle, ID 83616 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2016 |
Last Update Date | 11/09/2020 |