Doctor Name: | DR. MARK D MCDONOUGH |
NPI Number: | 1386652949 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | ME71478 |
Business Practice Address: | 4680 Millenia Plaza Way Orlando, FL - 328392434 |
Business Phone Number: | 4078964440 |
Business Fax Number: | 4078964410 |
Mailing Address: | Po Box 540929, ORLANDO |
State: | FL |
Postal Code: | 328540929 |
Phone Number: | 4078964440 |
Fax Number: | 4078964410 |
NPI Enumeration Date: | 08/03/2006 |
NPI Last Update Date: | 06/02/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | ME71478 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |