Provider Demographics
NPI:1679211072
Name:MCDONOUGH, WILL G (MD)
Entity Type:Individual
Prefix:DR
First Name:WILL
Middle Name:G
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 1:18511 HIGHLANDER MEDICS ST
Mailing Address - Street 2:MCHM-DOS-GSR
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79906
Mailing Address - Country:US
Mailing Address - Phone:915-742-0730
Mailing Address - Fax:915-742-7889
Practice Address - Street 1:18511 HIGHLANDER MEDICS ST
Practice Address - Street 2:MCHM-DOS-GSR
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79906
Practice Address - Country:US
Practice Address - Phone:915-742-0730
Practice Address - Fax:915-742-7889
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXU7011171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program