=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962808139
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DARIA P. MCDONOUGH, DPM
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2014
-----------------------------------------------------
Last Update Date | 11/14/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 284 N HALIFAX DR
-----------------------------------------------------
City | ORMOND BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32176-5765
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-672-9932
-----------------------------------------------------
Fax | 386-672-4201
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 4211
-----------------------------------------------------
City | ORMOND BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32175-4211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-672-9932
-----------------------------------------------------
Fax | 386-672-4201
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DARIA P. MCDONOUGH
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 386-672-9932
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------