Provider Demographics
NPI:1336283563
Name:DONALD, IAN ROSS (MD)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:ROSS
Last Name:DONALD
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 1:775 SW 9TH ST STE H
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-4876
Mailing Address - Country:US
Mailing Address - Phone:541-574-4767
Mailing Address - Fax:541-574-4747
Practice Address - Street 1:775 SW 9TH ST STE H
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-4876
Practice Address - Country:US
Practice Address - Phone:541-574-4767
Practice Address - Fax:541-574-4747
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24576207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010162464OtherBLUE SHIELD
ID000010162465OtherBLUE SHIELD
IDB5667OtherBLUE CROSS OF IDAHO
ID002704900Medicaid
IDB5667OtherBLUE CROSS OF IDAHO