Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 3025 | AZ |
NPI | 1649210758 |
---|---|
Provider Name | Frederick Mcdonald |
First Address | Phoenix, AZ 85034-7256 |
Second Address | Phoenix, AZ 85008-4973 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 08/07/2007 |