Healthcare Provider Details

I. General information

NPI: 1215485206
Provider Name (Legal Business Name): DAVID MACDONALD BS, MA, MED
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 09/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4575 SE DIXIE HWY
STUART FL
34997-6826
US

IV. Provider business mailing address

2240 47TH AVE
VERO BEACH FL
32966-2122
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone: 772-532-9743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: