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NPI Code Detail

MEDICARE: DR. DONALD A UNDERWOOD DO MD

MEDICARE: DR. DONALD A UNDERWOOD DO MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician20A4681CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1598861817
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DONALD A UNDERWOOD DO MD
Provider Business Mailing Address
First Line : 1963 NORTH E STREET
Second Line :
City : SAN BERNARDINO
State : CA
Zip : 92405-3919
Country : US
Telephone Number : 909-881-6146
Fax Number : 909-881-0111
Provider Business Practice Location Address
First Line : 1963 NORTH E STREET
Second Line :
City : SAN BERNARDINO
State : CA
Zip : 92405-3919
Country : US
Telephone Number : 909-881-6146
Fax Number : 909-881-0111
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2006
Last Update Date : 07/08/2007

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Directions to “ DR. DONALD A UNDERWOOD DO MD” Practice Location

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