MEDICARE: AARON DAVID MCDONALD EDS, MED, LAT

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	2255A2300X	Athletic Trainer	J00262	LA

General Provider Information

NPI Number	:	1306289368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AARON DAVID MCDONALD EDS, MED, LAT

Provider Business Mailing Address
First Line	:	1500 W MCNEESE ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-4242
Country	:	US
Telephone Number	:	337-217-4410
Fax Number	:	337-217-4412

Provider Business Practice Location Address
First Line	:	1500 W MCNEESE ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-4242
Country	:	US
Telephone Number	:	337-217-4410
Fax Number	:	337-217-4412

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

Provider Enumeration Date	:	04/09/2013
Last Update Date	:	04/09/2013

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