Individual
JACK EDWARD MCKAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1034 MAR WALT DR UNIT 100, FORT WALTON BEACH, FL 32547-6637
(850) 863-2153
(850) 863-8085
Mailing address
1034 MAR WALT DR UNIT 100, FORT WALTON BEACH, FL 32547-6637
(850) 863-2153
(850) 863-8085
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
ME139390
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14417668
CAQH
FL
01
—
53WFA
BCBS FL
FL
05
—
801769
—
FL
Enumeration date
04/07/2014
Last updated
03/24/2021
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