Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 4301022872 | MI |
NPI | 1023091469 |
---|---|
Provider Name | Dr. Robert J Mcdonald |
First Address | Royal Oak, MI 48073-0998 |
Second Address | Royal Oak, MI 48073-0998 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D92482 | (02) |