Provider Demographics
NPI:1104582790
Name:MCGREGOR, ERIC CHRISTIAN (PA-C)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:CHRISTIAN
Last Name:MCGREGOR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 E BUSINESS 190 STE 254
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-2517
Mailing Address - Country:US
Mailing Address - Phone:254-390-9110
Mailing Address - Fax:
Practice Address - Street 1:2520 TRIMMIER RD
Practice Address - Street 2:SUTIE 100
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541
Practice Address - Country:US
Practice Address - Phone:254-390-9110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-09
Last Update Date:2023-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA15078363A00000X
TXTEMPORARY363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant