Healthcare Provider Details

I. General information

NPI: 1518940006
Provider Name (Legal Business Name): SCOTT T MACDONALD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 04/30/2020
Certification Date: 04/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3160 FOLSOM BLVD STE 300
SACRAMENTO CA
95816-5202
US

IV. Provider business mailing address

3160 FOLSOM BLVD STE 300
SACRAMENTO CA
95816-5202
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-7777
  • Fax:
Mailing address:
  • Phone: 916-734-7777
  • Fax: 916-734-8059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA066223
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2083C0008X
TaxonomyClinical Informatics Physician
License NumberA066223
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: