Provider Demographics
NPI:1518121664
Name:MCDONALD, DOUGLAS RIVINGTON (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:RIVINGTON
Last Name:MCDONALD
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 1:1098 CHARTER ROW
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-4357
Mailing Address - Country:US
Mailing Address - Phone:423-335-4750
Mailing Address - Fax:
Practice Address - Street 1:#1 DOGWOOD LANE
Practice Address - Street 2:DEPT. OF SURGERY
Practice Address - City:MOUNTAIN HOME
Practice Address - State:TN
Practice Address - Zip Code:37684
Practice Address - Country:US
Practice Address - Phone:423-439-6267
Practice Address - Fax:423-439-6259
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000051685208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery