MEDICARE: DR. DONALD J TINDALL M.D.

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	208D00000X	General Practice Physician	ME 21406	FL

General Provider Information

NPI Number	:	1902973399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD J TINDALL M.D.

Provider Business Mailing Address
First Line	:	720 N BAY ST
Second Line	:	SUITE 11
City	:	EUSTIS
State	:	FL
Zip	:	32726-2964
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	720 N BAY ST
Second Line	:	SUITE 11
City	:	EUSTIS
State	:	FL
Zip	:	32726-2964
Country	:	US
Telephone Number	:	352-483-1600
Fax Number	:

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

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	11/28/2007

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