Healthcare Provider Details

I. General information

NPI: 1245230978
Provider Name (Legal Business Name): STEPHEN HUGH MACDONALD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 10/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 GATEWAY DR STE 2H
MELBOURNE FL
32901-2607
US

IV. Provider business mailing address

3300 S FISKE BLVD
ROCKLEDGE FL
32955-4306
US

V. Phone/Fax

Practice location:
  • Phone: 321-725-4500
  • Fax: 321-434-8881
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberOS6246
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: