Healthcare Provider Details

I. General information

NPI: 1790795250
Provider Name (Legal Business Name): JAMES C MCDANNALD DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 02/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 COBURG RD SLOCUM ORTHOPEDICS PC
EUGENE OR
97401-2433
US

IV. Provider business mailing address

55 COBURG RD SLOCUM ORTHOPEDICS PC
EUGENE OR
97401-2433
US

V. Phone/Fax

Practice location:
  • Phone: 541-485-8111
  • Fax: 541-868-0883
Mailing address:
  • Phone: 541-485-8111
  • Fax: 541-868-0883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberLL15335
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberDP00376
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierP00361972
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerMC RAILROAD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: