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Individual

SUSAN MCDONALD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
1400 8TH AVE, FORT WORTH, TX 76104-4110
(817) 269-1472
(817) 531-2939
Mailing address
1169 N BURLESON BLVD # 107-233, BURLESON, TX 76028-7011
(817) 269-1472
(817) 531-2939

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
88493
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
208094511
FEDERAL TAX ID
TX
Enumeration date
08/10/2016
Last updated
08/10/2016
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