MEDICARE: PACIFIC WOUND CENTER MEDICAL GROUP, INC.

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
1	207R00000X	Internal Medicine Physician	G74876	CA
2	213E00000X	Podiatrist	E3287	CA
3	207RC0000X	Cardiovascular Disease Physician	A31110	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ07794Z	OTHER	CA	BLUE SHIELD
2	ZZZ07794Z	OTHER		BLUE SHIELD

General Provider Information

NPI Number	:	1659399202
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC WOUND CENTER MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	4722 QUAIL LAKES DR
Second Line	:	SUITE A
City	:	STOCKTON
State	:	CA
Zip	:	95207-5256
Country	:	US
Telephone Number	:	209-476-0675
Fax Number	:	209-476-9389

Provider Business Practice Location Address
First Line	:	4722 QUAIL LAKES DR
Second Line	:	SUITE A
City	:	STOCKTON
State	:	CA
Zip	:	95207-5256
Country	:	US
Telephone Number	:	209-476-0675
Fax Number	:	209-476-9389

Authorized Official
Title or Position	:	OWNER/AUTHORIZED OFFICIAL,(PER PECO
Name	:	DR. WILLIAM D. MCDONALD
Credential	:	D.P.M.
Telephone Number	:	209-476-0675

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	11/23/2015

Similar Medicare Providers

1073172896 — MUHTADA ABDULELAH KAMAL ALDIN
Practice Location Address:

4722 QUAIL LAKES DR STE B
STOCKTON, CA
95207-5256

Practice Phone: 209-471-1848
Practice Fax: 209-472-0133

1629008339 — ANNETTE MARIA SEILER MD
Practice Location Address:

4722 QUAIL LAKES DR , SUITE A
STOCKTON, CA
95207-5256

Practice Phone: 209-476-0675
Practice Fax: 209-476-9389

1902914963 — WILLIAM D MCDONALD DPM
Practice Location Address:

4722 QUAIL LAKES DR , SUITE A
STOCKTON, CA
95207-5256

Practice Phone: 209-476-0675
Practice Fax: 209-476-9389

1245434083 — DAN VONGTAMA M.D.
Practice Location Address:

4722 QUAIL LAKES DR
STOCKTON, CA
95207-5256

Practice Phone: 209-472-1848
Practice Fax: 209-472-0133

1962805630 — CORKY HUL MEDICAL ASSOC
Practice Location Address:

4722 QUAIL LAKES DR
STOCKTON, CA
95207-5256

Practice Phone: 209-610-1800
Practice Fax:

1346928009 — BAY AREA FOOT CARE, INC
Practice Location Address:

4722 QUAIL LAKES DR STE A
STOCKTON, CA
95207-5256

Practice Phone: 209-476-0675
Practice Fax: 209-476-9389

Directions to “PACIFIC WOUND CENTER MEDICAL GROUP, INC. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.