Provider Demographics
NPI:1285671305
Name:MCDONALD, ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31493 RANCHO PUEBLO RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-4832
Mailing Address - Country:US
Mailing Address - Phone:951-303-3337
Mailing Address - Fax:951-303-2810
Practice Address - Street 1:31493 RANCHO PUEBLO RD
Practice Address - Street 2:SUITE 107
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-4832
Practice Address - Country:US
Practice Address - Phone:951-303-3337
Practice Address - Fax:951-303-2810
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044397207Q00000X
CAA97178207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H86233Medicare UPIN
CAWA97178BMedicare PIN
CAW14833Medicare PIN