Provider Demographics
NPI:1376631044
Name:JOHN T. MCDONNOLD II DO FACEP
Entity Type:Organization
Organization Name:JOHN T. MCDONNOLD II DO FACEP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MCDONNOLD
Authorized Official - Suffix:II
Authorized Official - Credentials:DO FACEP
Authorized Official - Phone:979-251-8210
Mailing Address - Street 1:2455 CLAY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BRENHAM
Mailing Address - State:TX
Mailing Address - Zip Code:77833-6328
Mailing Address - Country:US
Mailing Address - Phone:979-251-8210
Mailing Address - Fax:
Practice Address - Street 1:2455 CLAY CREEK RD
Practice Address - Street 2:
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-6328
Practice Address - Country:US
Practice Address - Phone:979-251-8210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1310207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF33330Medicare UPIN