Basic Information
| Provider Information | |||||||||
| NPI: | 1528077328 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCGRATH | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | JAY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 44018 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322314018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042443312 | ||||||||
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| Practice Location | |||||||||
| Address1: | 655 W 8TH ST | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322096511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042445431 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2006 | ||||||||
| LastUpdateDate: | 05/08/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MD15993 | DC | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | D0046844 | MD | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | G56037 | CA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 18735 | NC | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | ME131983 | FL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 027208100 | 05 | DC | MEDICAID |