Provider Demographics
NPI:1437263696
Name:MCCONNELL, DOUGLAS HUNTER (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:HUNTER
Last Name:MCCONNELL
Suffix:
Gender:M
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:PO BOX 991826
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96099-1826
Mailing Address - Country:US
Mailing Address - Phone:530-244-5833
Mailing Address - Fax:866-647-3121
Practice Address - Street 1:821 CHERRYHILL TRL
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-2834
Practice Address - Country:US
Practice Address - Phone:530-605-8013
Practice Address - Fax:866-647-3121
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24881208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A248810Medicaid
CA00A248810Medicaid
CAWA24881AMedicare ID - Type UnspecifiedMEDICARE IND NUMBER
CACE999ZMedicare PIN