Provider Demographics
NPI:1659824126
Name:MCDONALD, PAUL THOMAS JR (MPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:THOMAS
Last Name:MCDONALD
Suffix:JR
Gender:M
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 N HALL ST STE 400
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75226-1316
Mailing Address - Country:US
Mailing Address - Phone:469-800-7400
Mailing Address - Fax:
Practice Address - Street 1:621 N HALL ST STE 400
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75226-1316
Practice Address - Country:US
Practice Address - Phone:469-800-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-01
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX364317301Medicaid
TX532801YKY6Medicare PIN
TX364317301Medicaid