Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | ME0051842 | FL |
NPI | 1124067269 |
---|---|
Provider Name | Robert John Mcdonald |
First Address | Sanibel, FL 33957-7005 |
Second Address | Sanibel, FL 33957-7005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 22/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04699 | BCBS (01) | |
10715379 | CAQH (01) | FL |
2324753 | AETNA HMO (01) | |
258700900 | (05) | FL |
4388637 | AETNA PPO (01) | |
D61126 | (02) | |
ME51842 | FLORIDA LICENSE (01) | FL |