Provider Demographics
NPI:1356679757
Name:D D MCDONALD MD & ASSOCIATES
Entity Type:Organization
Organization Name:D D MCDONALD MD & ASSOCIATES
Other - Org Name:DR. D.D. MCDONALD MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN/OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEWARD
Authorized Official - Middle Name:DEWITT
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-753-0306
Mailing Address - Street 1:717 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5438
Mailing Address - Country:US
Mailing Address - Phone:903-753-0306
Mailing Address - Fax:903-753-0631
Practice Address - Street 1:717 N 4TH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5438
Practice Address - Country:US
Practice Address - Phone:903-753-0306
Practice Address - Fax:903-753-0631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-23
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC5174207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC5174OtherSTATE LISCENSE
TX031317301Medicaid
TX0A5571Medicare PIN
TXC5174OtherSTATE LISCENSE