Provider Demographics
NPI:1538890066
Name:MCQUEARY, MICHAEL JASON
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JASON
Last Name:MCQUEARY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 HIDDEN HILLS PKWY
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-5136
Mailing Address - Country:US
Mailing Address - Phone:601-983-8754
Mailing Address - Fax:
Practice Address - Street 1:250 HIDDEN HILLS PKWY
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39047-5136
Practice Address - Country:US
Practice Address - Phone:601-983-8754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant