Provider Demographics
NPI:1790729127
Name:MACDONALD, WARREN F JR (MD)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:F
Last Name:MACDONALD
Suffix:JR
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 1:1015 UNITY RD
Mailing Address - Street 2:
Mailing Address - City:CROSSETT
Mailing Address - State:AR
Mailing Address - Zip Code:71635-9443
Mailing Address - Country:US
Mailing Address - Phone:870-364-1490
Mailing Address - Fax:870-364-1465
Practice Address - Street 1:1015 UNITY RD
Practice Address - Street 2:
Practice Address - City:CROSSETT
Practice Address - State:AR
Practice Address - Zip Code:71635-9443
Practice Address - Country:US
Practice Address - Phone:870-364-1490
Practice Address - Fax:870-364-1465
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME16671207X00000X
ARE-8878207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEP00176796OtherRAILROAD MEDICARE
ME416190099Medicaid
AR370911YJ7ZMedicare PIN
ME416190099Medicaid
ME416190099Medicaid