Provider Demographics
NPI:1588669774
Name:MCDONOUGH, PAUL WILKINSON (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:WILKINSON
Last Name:MCDONOUGH
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 1:1701 PINE ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-3043
Mailing Address - Country:US
Mailing Address - Phone:325-677-6219
Mailing Address - Fax:325-677-0129
Practice Address - Street 1:1701 PINE ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-3043
Practice Address - Country:US
Practice Address - Phone:325-677-6219
Practice Address - Fax:325-677-0129
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1936207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX094750901Medicaid
TX200041431OtherRAILROAD MEDICARE
TX8B1030OtherBLUE CROSS BLUE SHIELD OF TEXAS
TX094750901Medicaid