MEDICARE: PAUL THOMAS MCDONALD JR. MPAS, PA-C

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	363A00000X	Physician Assistant		TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659824126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL THOMAS MCDONALD JR. MPAS, PA-C

Provider Business Mailing Address
First Line	:	621 N HALL ST STE 400
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75226-1316
Country	:	US
Telephone Number	:	469-800-7400
Fax Number	:

Provider Business Practice Location Address
First Line	:	621 N HALL ST STE 400
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75226-1316
Country	:	US
Telephone Number	:	469-800-7400
Fax Number	:

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

Provider Enumeration Date	:	08/01/2016
Last Update Date	:	04/05/2022

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