Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | ME0039051 | FL |
NPI | 1043254964 |
---|---|
Provider Name | John W Mcdonald |
First Address | Vero Beach, FL 32960-4813 |
Second Address | Vero Beach, FL 32960-4813 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D67325 | (02) | FL |