Provider Demographics
NPI:1104846815
Name:MCDONALD, DAVID J (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MIRROR LAKE DR
Mailing Address - Street 2:STE A
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-3101
Mailing Address - Country:US
Mailing Address - Phone:386-673-2500
Mailing Address - Fax:386-673-3204
Practice Address - Street 1:8 MIRROR LAKE DR
Practice Address - Street 2:STE A
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-3101
Practice Address - Country:US
Practice Address - Phone:386-673-2500
Practice Address - Fax:386-673-3204
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0070742174400000X
FLME0707422084D0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084D0003XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyDiagnostic Neuroimaging
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250565700Medicaid
FL250565700Medicaid
31235XMedicare PIN
FL31235Medicare ID - Type Unspecified