Provider Demographics
NPI:1023098415
Name:MCDONALD, TERENCE D (DPM)
Entity type:Individual
Prefix:DR
First Name:TERENCE
Middle Name:D
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5430 BUCHANAN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-5708
Mailing Address - Country:US
Mailing Address - Phone:954-771-5900
Mailing Address - Fax:954-771-5959
Practice Address - Street 1:6405 N FEDERAL HWY
Practice Address - Street 2:SUITE 405
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-1412
Practice Address - Country:US
Practice Address - Phone:954-771-5900
Practice Address - Fax:954-771-5959
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO0002404213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65332Medicare ID - Type Unspecified
FLU48310Medicare UPIN