Provider Demographics
NPI:1295807006
Name:MCDONALD, ROBERT LEWIS (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEWIS
Last Name:MCDONALD
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 1:200 BATH ST
Mailing Address - Street 2:STE 1
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703
Mailing Address - Country:US
Mailing Address - Phone:775-882-2106
Mailing Address - Fax:775-882-0838
Practice Address - Street 1:200 BATH ST
Practice Address - Street 2:STE 1
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703
Practice Address - Country:US
Practice Address - Phone:775-882-2106
Practice Address - Fax:775-882-0838
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6433207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002013138Medicaid
NV6433OtherNV LIC
BM1268944OtherDEA USA
NV6433OtherNV LIC