Healthcare Provider Details

I. General information

NPI: 1861491060
Provider Name (Legal Business Name): MICHAEL ALLEN MCDONALD PA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 W COURT ST
NEWTON TX
75966-3010
US

IV. Provider business mailing address

2548 MEMORIAL BLVD
PORT ARTHUR TX
77640-2825
US

V. Phone/Fax

Practice location:
  • Phone: 409-379-8338
  • Fax: 409-983-4933
Mailing address:
  • Phone: 409-983-1161
  • Fax: 409-983-4933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPA-01009
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: