Provider Demographics
NPI:1235171265
Name:DONALD, CATHERINE (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:
Last Name:DONALD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CATHERINE
Other - Middle Name:
Other - Last Name:DONALD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2500 NORTH STATE STREET
Mailing Address - Street 2:JMM SUITE 2525
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216
Mailing Address - Country:US
Mailing Address - Phone:601-815-9528
Mailing Address - Fax:601-984-6439
Practice Address - Street 1:12100 HIGHWAY 49
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3063
Practice Address - Country:US
Practice Address - Phone:228-831-1988
Practice Address - Fax:228-831-1978
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16916208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00122908Medicaid
MS512I370095Medicare PIN
MS302I375963Medicare PIN
MS00122908Medicaid
MSH34286Medicare UPIN
MS302I375963Medicare PIN
MS$$$$$$$$$AOtherBCBS
MS$$$$$$$$$EOtherBCBS
MS512I370095Medicare PIN
MS370000321Medicare ID - Type Unspecified
MS00122908Medicaid