Provider Demographics
NPI:1770900490
Name:MCDONALD, ROBERT LESTER JR
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LESTER
Last Name:MCDONALD
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3649 CEDAR RUN ROAD
Mailing Address - Street 2:APT 106
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606
Mailing Address - Country:US
Mailing Address - Phone:850-803-1224
Mailing Address - Fax:
Practice Address - Street 1:3649 CEDAR RUN RD
Practice Address - Street 2:APT 106
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-2447
Practice Address - Country:US
Practice Address - Phone:850-803-1224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-19
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians