Provider Demographics
NPI:1154600765
Name:MACGILLIVRAY, DAVID ALEX (DOM AP)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ALEX
Last Name:MACGILLIVRAY
Suffix:
Gender:M
Credentials:DOM AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W 6TH AVE # D
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-3525
Mailing Address - Country:US
Mailing Address - Phone:407-484-7600
Mailing Address - Fax:
Practice Address - Street 1:120 W 6TH AVE
Practice Address - Street 2:SUITE D
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-3525
Practice Address - Country:US
Practice Address - Phone:407-484-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-12
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2935171100000X
NY004548171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist