Provider Demographics
NPI:1114924305
Name:MCTAGGART, JOHN DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DAVID
Last Name:MCTAGGART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:122 LINSLEY AVE
Mailing Address - Street 2:STE A
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5121
Mailing Address - Country:US
Mailing Address - Phone:813-657-4914
Mailing Address - Fax:813-657-4916
Practice Address - Street 1:613 OAKFIELD DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5714
Practice Address - Country:US
Practice Address - Phone:813-661-2222
Practice Address - Fax:813-681-8494
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 382212085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
D56017Medicare UPIN
FL51240Medicare ID - Type Unspecified