Provider Demographics
NPI:1396006433
Name:MCDONALD, TREMAINE IKE (BHRS)
Entity Type:Individual
Prefix:
First Name:TREMAINE
Middle Name:IKE
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7179 ASHLEY TRL
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73025-2563
Mailing Address - Country:US
Mailing Address - Phone:405-556-0309
Mailing Address - Fax:
Practice Address - Street 1:7179 ASHLEY TRL
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73025-2563
Practice Address - Country:US
Practice Address - Phone:405-556-0309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor