Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VX0000X | Obstetrician | 39349 | KY |
Y | 207VX0201X | Gynecologic Oncologist | 9801384 | NC |
NPI | 1467496869 |
---|---|
Provider Name | John Matthew Mcdonald |
First Address | Charlotte, NC 28260-0447 |
Second Address | Charlotte, NC 28204-3215 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 19/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5909347 | (05) | NC |
64102924 | (05) | KY |