Provider Demographics
NPI:1740265172
Name:MCDONALD, HARRISON R (MD)
Entity type:Individual
Prefix:DR
First Name:HARRISON
Middle Name:R
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 1:320 SANTA FE DR
Mailing Address - Street 2:SUITE 207
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5140
Mailing Address - Country:US
Mailing Address - Phone:760-436-8866
Mailing Address - Fax:760-436-9838
Practice Address - Street 1:320 SANTA FE DR
Practice Address - Street 2:SUITE 207
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5140
Practice Address - Country:US
Practice Address - Phone:760-436-8866
Practice Address - Fax:760-436-9838
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC32355207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC32355OtherCA LICENSE #
CAC32355Medicare ID - Type UnspecifiedCA LICENSE IS MEDICARE ID
CAA34909Medicare UPIN