MEDICARE: JOEL DOUGLAS 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	207T00000X	Neurological Surgery Physician	183354-1205	UT

General Provider Information

NPI Number	:	1487744090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL DOUGLAS MACDONALD MD

Provider Business Mailing Address
First Line	:	2660 E 3300 S APT 19
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-2761
Country	:	US
Telephone Number	:	801-244-6959
Fax Number	:

Provider Business Practice Location Address
First Line	:	82 S 1100 E STE 103
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-1889
Country	:	US
Telephone Number	:	801-505-5370
Fax Number	:	801-984-6657

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	04/09/2019

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