Provider Demographics
NPI:1326509092
Name:MCDONALD, CHELSEA LEIGH (DO)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:LEIGH
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 W 19TH ST
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-2628
Mailing Address - Country:US
Mailing Address - Phone:479-283-4578
Mailing Address - Fax:
Practice Address - Street 1:8551 N 125TH EAST AVE STE 175
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-2297
Practice Address - Country:US
Practice Address - Phone:918-265-3797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7014207Q00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine