Provider Demographics
NPI:1245284256
Name:MACDONALD, JOHN W (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:202 NORTH CHURCH STREET
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TX
Mailing Address - Zip Code:77535-2604
Mailing Address - Country:US
Mailing Address - Phone:936-258-2634
Mailing Address - Fax:936-258-7304
Practice Address - Street 1:202 NORTH CHURCH STREET
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TX
Practice Address - Zip Code:77535-2604
Practice Address - Country:US
Practice Address - Phone:936-258-2634
Practice Address - Fax:936-258-7304
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2008-06-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXF7518207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00LR46OtherBLUE CROSS BLUE SHIELD
TX3166859OtherHMO BLUE
TX5259005OtherAETNA
TX2814679010OtherCIGNA
TX3166859OtherHMO BLUE
TX2814679010OtherCIGNA