Provider Demographics
NPI:1871644534
Name:MCDONALD, BRUCE BRADFORD (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:BRADFORD
Last Name:MCDONALD
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 1:5220 SERRANO TRL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78734-1031
Mailing Address - Country:US
Mailing Address - Phone:512-866-3744
Mailing Address - Fax:512-597-0663
Practice Address - Street 1:5220 SERRANO TRL
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78734-1031
Practice Address - Country:US
Practice Address - Phone:512-866-3744
Practice Address - Fax:512-597-0663
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE0261208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC19126Medicare UPIN