Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | P0979 | FL |
Y | 222Z00000X | Podiatrist | P0979 | FL |
NPI | 1043206535 |
---|---|
Provider Name | Michael W Mcdonough |
First Address | Ormond Beach, FL 32174-5190 |
Second Address | Ormond Beach, FL 32174-5190 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2005 |
Last Update Date | 07/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T95161 | (02) |