Provider Demographics
NPI:1801973078
Name:MCDONALD, PAUL W (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:W
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 1:2208 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-4002
Mailing Address - Country:US
Mailing Address - Phone:330-904-2021
Mailing Address - Fax:
Practice Address - Street 1:1615 SW 8TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1633
Practice Address - Country:US
Practice Address - Phone:785-368-2095
Practice Address - Fax:785-368-2098
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-31919207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS171813Medicare PIN
KS171814Medicare PIN
KS171815Medicare PIN
KS171810Medicare PIN