Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 4488 | AZ |
Y | 103T00000X | Psychologist | 4488 | AZ |
NPI | 1003227257 |
---|---|
Provider Name | Dr. Brian M Mcdonald |
First Address | Phoenix, AZ 85012-2331 |
Second Address | Phoenix, AZ 85012-2331 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2014 |
Last Update Date | 09/05/2014 |