Healthcare Provider Details

I. General information

NPI: 1487744090
Provider Name (Legal Business Name): JOEL DOUGLAS MACDONALD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 11/03/2026
Certification Date: 11/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 E KIMBALLS LN STE 306
DRAPER UT
84020-5028
US

IV. Provider business mailing address

PO BOX 198560
ATLANTA GA
30384-8560
US

V. Phone/Fax

Practice location:
  • Phone: 801-576-2300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number183354-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: