Provider Demographics
NPI:1750375341
Name:MCDONALD, JAMES FLETCHER (DPM)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:FLETCHER
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 1:2324 SANTA RITA RD STE 15
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-4150
Mailing Address - Country:US
Mailing Address - Phone:925-462-9662
Mailing Address - Fax:925-455-1595
Practice Address - Street 1:2324 SANTA RITA RD STE 15
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-4150
Practice Address - Country:US
Practice Address - Phone:925-462-9662
Practice Address - Fax:925-455-1595
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3676213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E36760Medicaid
U04506Medicare UPIN
CA000E36760Medicaid