Provider Demographics
NPI:1891798484
Name:MCDONALD, TEDD MIKEL (MD)
Entity Type:Individual
Prefix:
First Name:TEDD
Middle Name:MIKEL
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4200 SANTA FE DR
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406-5248
Mailing Address - Country:US
Mailing Address - Phone:775-217-3095
Mailing Address - Fax:775-423-2707
Practice Address - Street 1:485 W B ST STE 105
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-2765
Practice Address - Country:US
Practice Address - Phone:775-423-6695
Practice Address - Fax:775-423-8057
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV11898207VG0400X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H68626Medicare UPIN
00113HMedicare ID - Type Unspecified
NVV103470Medicare PIN