Provider Demographics
NPI:1013982511
Name:MCDONALD, CHERYL K (MD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:K
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4514
Mailing Address - Country:US
Mailing Address - Phone:817-810-9810
Mailing Address - Fax:817-810-9815
Practice Address - Street 1:1125 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4514
Practice Address - Country:US
Practice Address - Phone:817-810-9810
Practice Address - Fax:817-810-9815
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7634207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89860JOtherBCBS
440002173OtherMEDICARE RAILROAD
TX047670701Medicaid
752712328OtherTAX ID NUMBER
TX89860JOtherBCBS
E44248Medicare UPIN