MEDICARE: KENT MCDONALD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	06469	UT

General Provider Information

NPI Number	:	1093794554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENT MCDONALD MD

Provider Business Mailing Address
First Line	:	515 S 300 E
Second Line	:	SUITE #105
City	:	ST GEORGE
State	:	UT
Zip	:	84770-3900
Country	:	US
Telephone Number	:	435-628-2814
Fax Number	:	435-674-7112

Provider Business Practice Location Address
First Line	:	515 S 300 E
Second Line	:	SUITE #105
City	:	ST GEORGE
State	:	UT
Zip	:	84770-3900
Country	:	US
Telephone Number	:	435-628-2814
Fax Number	:	435-674-7112

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	03/12/2013

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