Provider Demographics
NPI:1518271097
Name:MACDONALD, GARY PATRICK (DO)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:PATRICK
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:GARY
Other - Middle Name:PATRICK
Other - Last Name:RAITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5148 N LONG SKY DR
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-7391
Mailing Address - Country:US
Mailing Address - Phone:435-602-3272
Mailing Address - Fax:
Practice Address - Street 1:965 E 700 S STE 205
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4085
Practice Address - Country:US
Practice Address - Phone:435-574-9146
Practice Address - Fax:435-574-9147
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT85317151204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine