Provider Demographics
NPI:1609860956
Name:MCDONALD, JUDY L (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:L
Last Name:MCDONALD
Suffix:
Gender:F
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:PO BOX 21250
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71903-1250
Mailing Address - Country:US
Mailing Address - Phone:501-318-2929
Mailing Address - Fax:501-318-2828
Practice Address - Street 1:3604 CENTRAL AVE
Practice Address - Street 2:SUITE B
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6403
Practice Address - Country:US
Practice Address - Phone:501-318-2929
Practice Address - Fax:501-318-2828
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-01
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR3847207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR114748001Medicaid
AR52149OtherBLUE SHIELD
AR52149Medicare ID - Type Unspecified
ARD00726Medicare UPIN