Provider Demographics
NPI:1831392489
Name:TOM MCDONALD MD PLLC
Entity type:Organization
Organization Name:TOM MCDONALD MD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:731-968-9965
Mailing Address - Street 1:270 W CHURCH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LEXINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38351-2077
Mailing Address - Country:US
Mailing Address - Phone:731-968-9965
Mailing Address - Fax:731-968-1940
Practice Address - Street 1:270 W CHURCH ST
Practice Address - Street 2:SUTIE A
Practice Address - City:LEXINGTON
Practice Address - State:TN
Practice Address - Zip Code:38351-2077
Practice Address - Country:US
Practice Address - Phone:731-968-9965
Practice Address - Fax:731-968-1940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23828207R00000X
TNMD0000023828207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3725379Medicaid
TN3725379OtherMEDICARE PTAN
TN3725379OtherMEDICARE PTAN