MEDICARE: WILLIAM D MCDONALD DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	E3287	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ28592Z	OTHER	CA	MEDICARE - ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	E3287	OTHER	CA	STATE LICENSE #

General Provider Information

NPI Number	:	1902914963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM D MCDONALD DPM

Provider Business Mailing Address
First Line	:	4722 QUAIL LAKES DR
Second Line	:	SUITE A
City	:	STOCKTON
State	:	CA
Zip	:	95207-5256
Country	:	US
Telephone Number	:	209-476-0675
Fax Number	:	209-476-9389

Provider Business Practice Location Address
First Line	:	4722 QUAIL LAKES DR
Second Line	:	SUITE A
City	:	STOCKTON
State	:	CA
Zip	:	95207-5256
Country	:	US
Telephone Number	:	209-476-0675
Fax Number	:	209-476-9389

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	11/04/2015

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