Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | MD.42771 | AL |
NPI | 1952795577 |
---|---|
Provider Name | Tyler C Mcdonald |
First Address | Mobile, AL 36640-0480 |
Second Address | Mobile, AL 36604-1541 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2015 |
Last Update Date | 14/07/2021 |