Provider Demographics
NPI:1396814307
Name:MCDONALD, LORRAINE KAY (MD)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:KAY
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 S OREGON ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97530-9337
Mailing Address - Country:US
Mailing Address - Phone:541-899-5641
Mailing Address - Fax:541-899-5641
Practice Address - Street 1:1250 SISKIYOU BLVD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-5001
Practice Address - Country:US
Practice Address - Phone:541-552-6137
Practice Address - Fax:541-552-6693
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD24091207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H08595Medicare UPIN