Provider Demographics
NPI:1780184861
Name:MCDONALD, PATRICK JON
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:JON
Last Name:MCDONALD
Suffix:
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 1:834 MULBERRY DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-5817
Mailing Address - Country:US
Mailing Address - Phone:214-960-6119
Mailing Address - Fax:469-702-6664
Practice Address - Street 1:834 MULBERRY DR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-5817
Practice Address - Country:US
Practice Address - Phone:214-960-6119
Practice Address - Fax:469-702-6664
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical