Healthcare Provider Details

I. General information

NPI: 1366426249
Provider Name (Legal Business Name): DOUGLAS MCDONALD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: G. DOUGLAS MCDONALD MD

II. Dates (important events)

Enumeration Date: 12/03/2005
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15670 REDMOND WAY
REDMOND WA
98052-3831
US

IV. Provider business mailing address

PO BOX 84026
SEATTLE WA
98124-8426
US

V. Phone/Fax

Practice location:
  • Phone: 206-320-5190
  • Fax: 206-320-5191
Mailing address:
  • Phone: 206-320-4476
  • Fax: 206-568-7043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number22624
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: