MEDICARE: DR. SAMUEL IVES MACDONALD 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	2084P0800X	Psychiatry Physician	MD2026-0540	NM

General Provider Information

NPI Number	:	1265007256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL IVES MACDONALD MD

Provider Business Mailing Address
First Line	:	MSC09 5030 1 UNIVERSITY OF NEW MEXICO
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87131-0001
Country	:	US
Telephone Number	:	505-272-5428
Fax Number	:	505-272-4639

Provider Business Practice Location Address
First Line	:	MSC09 5030 1 UNIVERSITY OF NEW MEXICO
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87131-0001
Country	:	US
Telephone Number	:	505-272-5428
Fax Number	:	505-272-4639

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

Provider Enumeration Date	:	05/23/2021
Last Update Date	:	06/01/2026

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