Healthcare Provider Details

I. General information

NPI: 1659367803
Provider Name (Legal Business Name): SHARON GAIL MCDONALD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3844 S LINDBERGH BLVD SUITE 240
SUNSET HILLS MO
63127-1368
US

IV. Provider business mailing address

3844 S LINDBERGH BLVD SUITE 240
SUNSET HILLS MO
63127-1368
US

V. Phone/Fax

Practice location:
  • Phone: 314-842-6630
  • Fax: 314-842-7543
Mailing address:
  • Phone: 314-842-6630
  • Fax: 314-842-7543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberR7853
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: