Provider Demographics
NPI:1184935827
Name:MCDONALD, BENJAMIN G (DO)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:G
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11415 EXECUTIVE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4489
Mailing Address - Country:US
Mailing Address - Phone:501-224-5220
Mailing Address - Fax:501-228-9828
Practice Address - Street 1:11415 EXECUTIVE CENTER DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-4489
Practice Address - Country:US
Practice Address - Phone:501-224-5220
Practice Address - Fax:501-228-9828
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-8580207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine