Provider Demographics
NPI:1821108846
Name:MCCONNELL, DONALD BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:BRUCE
Last Name:MCCONNELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:0236 SW RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-6572
Mailing Address - Country:US
Mailing Address - Phone:503-246-8306
Mailing Address - Fax:503-220-3415
Practice Address - Street 1:3710 SW US VETERANS HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-2964
Practice Address - Country:US
Practice Address - Phone:503-220-8262
Practice Address - Fax:503-220-3415
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORMDO9113208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORC93759Medicare UPIN