Provider Demographics
NPI:1750497095
Name:MCDONALD, MALCOLM (DO)
Entity Type:Individual
Prefix:DR
First Name:MALCOLM
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5415 LAKE HOWELL RD # 175
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-1033
Mailing Address - Country:US
Mailing Address - Phone:407-677-6500
Mailing Address - Fax:407-671-9593
Practice Address - Street 1:3009 ALOMA AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3701
Practice Address - Country:US
Practice Address - Phone:407-677-6500
Practice Address - Fax:407-671-9593
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0002437208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048079700Medicaid
FL81945YMedicare ID - Type Unspecified
FLD30584Medicare UPIN