Organization
MCDONNELL DERMATOLOGY LLC
Active
Organization
MCDONNELL DERMATOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONELLE K MCDONNELL MD (OWNER)
(941) 205-3376
Entity
Organization
Contact information
Practice address
25097 OLYMPIA AVE, STE 204, PUNTA GORDA, FL 33950-3903
(941) 205-6676
Mailing address
25097 OLYMPIA AVE, STE 204, PUNTA GORDA, FL 33950-3903
(941) 205-3376
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
ME104122
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ME104122
MEDICAL LICENSE NUMBER
FL
Enumeration date
07/14/2010
Last updated
07/31/2010
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