Provider Demographics
NPI:1881116762
Name:MCGHAN, JOHN WAYNE (DPM)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WAYNE
Last Name:MCGHAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13838 S 46TH PL STE 210
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-7803
Mailing Address - Country:US
Mailing Address - Phone:480-213-3011
Mailing Address - Fax:480-816-4483
Practice Address - Street 1:13838 S 46TH PL STE 210
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044
Practice Address - Country:US
Practice Address - Phone:480-213-3011
Practice Address - Fax:480-816-4483
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-12
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPOD-000937213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ001Other001