| James E Mcdonnell Md Plc | |
|
305 Clyde Morris Blvd Suite 130 Ormond Beach FL 32174-8181 | |
| (386) 677-6727 | |
| (386) 677-3211 |
| Full Name | James E Mcdonnell Md Plc |
|---|---|
| Speciality | Family Medicine |
| Location | 305 Clyde Morris Blvd, Ormond Beach, Florida |
| Authorized Official Name and Position | James Edward Mcdonnell (OWNER/PHYSICIAN/PRESIDENT) |
| Authorized Official Contact | 3866776727 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| James E Mcdonnell Md Plc 305 Clyde Morris Blvd Suite 130 Ormond Beach FL 32174-8181 Ph: (386) 677-6727 | James E Mcdonnell Md Plc 305 Clyde Morris Blvd Suite 130 Ormond Beach FL 32174-8181 Ph: (386) 677-6727 |
| NPI Number | 1013011584 |
|---|---|
| Provider Enumeration Date | 09/12/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013011584 | NPI | - | NPPES |
| DE7297 | Other | FL | RAILROAD MEDICARE |
| 14223 | Other | FL | BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | ME0058254 (Florida) | Primary |
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Mark W. Lastarza, M.d., Pa. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 335 Clyde Morris Blvd, Suite 290, Ormond Beach, FL 32174 Phone: 386-672-3219 Fax: 386-672-3160 | |
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