Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | H7634 | TX |
NPI | 1013982511 |
---|---|
Provider Name | Cheryl K Mcdonald |
First Address | Fort Worth, TX 76104-4514 |
Second Address | Fort Worth, TX 76104-4514 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2006 |
Last Update Date | 21/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
047670701 | (05) | TX |
440002173 | MEDICARE RAILROAD (01) | |
89860J | BCBS (01) | TX |
E44248 | (02) |