Provider Demographics
NPI:1376568139
Name:MCDONALD, DONALD LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:LEE
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:703 CALVIN AVERY DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-6501
Mailing Address - Country:US
Mailing Address - Phone:870-732-1878
Mailing Address - Fax:870-702-7111
Practice Address - Street 1:309 N 5TH ST
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-3213
Practice Address - Country:US
Practice Address - Phone:870-732-6600
Practice Address - Fax:870-732-6621
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE11892084P0800X
TNMD278302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN003121060OtherBCBS
TN3811482OtherMEDICARE
AR5K644OtherBCBS
TN242806000Medicaid
AR135506001Medicaid
TN242806000Medicaid
AR135506001Medicaid