Provider Demographics
NPI:1811945983
Name:MCDONALD, RODNEY K (MD)
Entity type:Individual
Prefix:
First Name:RODNEY
Middle Name:K
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 1:616 S 17TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-4700
Mailing Address - Country:US
Mailing Address - Phone:479-434-3333
Mailing Address - Fax:479-434-3535
Practice Address - Street 1:616 S 17TH ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-4700
Practice Address - Country:US
Practice Address - Phone:479-434-3333
Practice Address - Fax:479-434-3535
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2441207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR142890001Medicaid
OK100052490AMedicaid
AR5L789Medicare ID - Type Unspecified
AR142890001Medicaid