Provider Demographics
NPI:1558472910
Name:MCDONALD, JEFFREY DEAN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:DEAN
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1641 E. POLSTON AVE
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854
Mailing Address - Country:US
Mailing Address - Phone:208-777-7555
Mailing Address - Fax:208-777-3337
Practice Address - Street 1:980 W IRONWOOD DRIVE
Practice Address - Street 2:#206
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814
Practice Address - Country:US
Practice Address - Phone:208-667-4949
Practice Address - Fax:208-765-0348
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM7768208600000X
WAMD00042887208600000X
IDM-7768207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID003464400Medicaid
ID1376455OtherMDC GROUP
ID805400800OtherEDS GROUP
ID805400800OtherEDS GROUP
ID003464400Medicaid