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General NPI Number Information
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NPI Number | 1720115777
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Entity Type | Individual
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Provider Name | GARY L MCDONALD MD
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Gender | Male
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 06/21/2021
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Provider Practice Location Address
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Address Line | 280 EXEMPLA CIR
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City | LAFAYETTE
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State | CO
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Zip | 80026-3370
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Country | US
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Telephone | 303-338-4545
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Fax |
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Provider Business Mailing Address
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Address Line | 10350 E DAKOTA AVE
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City | DENVER
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State | CO
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Zip | 80247-1314
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Country | US
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Telephone | 303-338-4545
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 29908
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number | 29908
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License Number State | CO
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