Provider Demographics
NPI:1649589664
Name:MCDONOUGH, KATHERINE LEA (DO)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LEA
Last Name:MCDONOUGH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-302-6300
Mailing Address - Fax:208-302-6355
Practice Address - Street 1:10717 W STATE STREET
Practice Address - Street 2:
Practice Address - City:STAR
Practice Address - State:ID
Practice Address - Zip Code:83669
Practice Address - Country:US
Practice Address - Phone:208-302-6300
Practice Address - Fax:208-302-6355
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORDO172063207Q00000X
IDO-1059207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine