Individual
MR. JOSEPH C. MCTAVISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
1502
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0924PA
—
SC
Enumeration date
01/26/2010
Last updated
06/28/2021
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