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General NPI Number Information
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NPI Number | 1013011584
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Entity Type | Organization
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Legal Business Name | JAMES E MCDONNELL MD PLC
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Dates
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Enumeration Date | 09/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 305 CLYDE MORRIS BLVD SUITE 130
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City | ORMOND BEACH
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State | FL
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Zip | 32174-8181
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Country | US
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Telephone | 386-677-6727
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Fax | 386-677-3211
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Provider Business Mailing Address
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Address Line | 305 CLYDE MORRIS BLVD SUITE 130
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City | ORMOND BEACH
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State | FL
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Zip | 32174-8181
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Country | US
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Telephone | 386-677-6727
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Fax | 386-677-3211
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Authorized Official
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Title or Position | OWNER/PHYSICIAN/PRESIDENT
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Name | JAMES EDWARD MCDONNELL
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Credential | M.D.
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Telephone | 386-677-6727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME0058254
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License Number State | FL
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