Provider Demographics
NPI:1811094717
Name:MCDONALD, JAMES ROBERT (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ROBERT
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 1:875 OAK ST SE
Mailing Address - Street 2:#4000
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3907
Mailing Address - Country:US
Mailing Address - Phone:503-364-0189
Mailing Address - Fax:503-364-9288
Practice Address - Street 1:875 OAK ST SE
Practice Address - Street 2:#4000
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3907
Practice Address - Country:US
Practice Address - Phone:503-364-0189
Practice Address - Fax:503-364-9288
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD11103207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR227660Medicaid
OR230821Medicaid
R0000WCGQJMedicare ID - Type Unspecified
OR230821Medicaid