Healthcare Provider Details

I. General information

NPI: 1770611030
Provider Name (Legal Business Name): CURTIS RAY MCDONALD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 06/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5515 PIONEER ST
RIDGEFIELD WA
98642-3375
US

IV. Provider business mailing address

700 NE 87TH AVE
VANCOUVER WA
98664-4896
US

V. Phone/Fax

Practice location:
  • Phone: 360-882-2778
  • Fax: 360-604-1649
Mailing address:
  • Phone: 360-882-2778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2008-01315
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD60934883
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: