Provider Demographics
NPI:1255333605
Name:MCDONALD, RUSSELL R (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:R
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:4001 W 15TH ST STE 350
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5863
Practice Address - Country:US
Practice Address - Phone:972-596-2131
Practice Address - Fax:972-867-3549
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2021-04-09
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Provider Licenses
StateLicense IDTaxonomies
TXF1799208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114183002Medicaid