Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 35068909 M | OH |
NPI | 1003896333 |
---|---|
Provider Name | Dr. Mark G Mcdonald |
First Address | Lima, OH 45804-4099 |
Second Address | Lima, OH 45804-4099 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2006 |
Last Update Date | 01/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000021186 | ANTHEM (01) | OH |
0246979 | (05) | OH |
F57547 | (02) |