Provider Demographics
NPI:1821034869
Name:MCDONALD, JEFFREY JOHN
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:JOHN
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 N FIREWEED
Mailing Address - Street 2:STA A
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-7593
Mailing Address - Country:US
Mailing Address - Phone:907-262-8597
Mailing Address - Fax:
Practice Address - Street 1:247 N FIREWEED
Practice Address - Street 2:STE A
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7593
Practice Address - Country:US
Practice Address - Phone:907-262-8597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4800208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD91351Medicaid
P00064109OtherRAILROAD MEDICARE
AKMD91351Medicaid
P00064109OtherRAILROAD MEDICARE