Provider Demographics
NPI:1073935268
Name:MCCALL, DONALD RAY JR
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:RAY
Last Name:MCCALL
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2117 KENNETH RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-6632
Mailing Address - Country:US
Mailing Address - Phone:702-527-0633
Mailing Address - Fax:
Practice Address - Street 1:2117 KENNETH RD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-6632
Practice Address - Country:US
Practice Address - Phone:702-527-0633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker