Provider Demographics
NPI:1346280161
Name:JOHN P MCDONOUGH III
Entity Type:Organization
Organization Name:JOHN P MCDONOUGH III
Other - Org Name:GERIATRIC PSYCHOLOGICAL SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MCDONOUGH
Authorized Official - Suffix:III
Authorized Official - Credentials:PHD
Authorized Official - Phone:813-495-4773
Mailing Address - Street 1:2223 SHADEHILL CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-5024
Mailing Address - Country:US
Mailing Address - Phone:813-495-4773
Mailing Address - Fax:
Practice Address - Street 1:2223 SHADEHILL CT
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-5024
Practice Address - Country:US
Practice Address - Phone:813-495-4773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0175Medicare UPIN