Provider Demographics
NPI:1922000264
Name:MACDONALD, JAMES (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:MACDONALD
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 1:6325 E TANQUE VERDE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-3808
Mailing Address - Country:US
Mailing Address - Phone:520-795-5830
Mailing Address - Fax:520-885-4469
Practice Address - Street 1:6325 E TANQUE VERDE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-3808
Practice Address - Country:US
Practice Address - Phone:520-795-5830
Practice Address - Fax:520-885-4469
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17097208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ79845Medicaid
E98150Medicare UPIN
AZ79845Medicaid