Organization
PACIFIC WOUND CENTER MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM D. MCDONALD D.P.M. (OWNER/AUTHORIZED OFFICIAL,(PER PECO)
(209) 476-0675
Entity
Organization
Contact information
Practice address
4722 QUAIL LAKES DR, SUITE A, STOCKTON, CA 95207-5256
(209) 476-0675
(209) 476-9389
Mailing address
4722 QUAIL LAKES DR, SUITE A, STOCKTON, CA 95207-5256
(209) 476-0675
(209) 476-9389
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
G74876
CA
207RC0000X
Cardiovascular Disease Physician
Primary
A31110
CA
213E00000X
Podiatrist
E3287
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ07794Z
BLUE SHIELD
CA
01
—
ZZZ07794Z
BLUE SHIELD
—
Enumeration date
07/18/2006
Last updated
11/23/2015
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