Provider Demographics
NPI:1578784278
Name:MCDONALD, GREGORY LEE (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:LEE
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:311 B AVE STE L
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-3071
Mailing Address - Country:US
Mailing Address - Phone:503-699-6636
Mailing Address - Fax:844-270-0696
Practice Address - Street 1:311 B AVE
Practice Address - Street 2:SUITE L
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-3011
Practice Address - Country:US
Practice Address - Phone:503-699-6636
Practice Address - Fax:844-270-0696
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC01300171100000X
OR0660175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist