Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 23433 | MN |
NPI | 1306873625 |
---|---|
Provider Name | Dr. John Thomas Macdonald |
First Address | Golden Valley, MN 55422-4215 |
Second Address | Golden Valley, MN 55422-4215 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0265010 | PREFERRED ONE (01) | MN |
0501645 | MEDICA (01) | MN |
10534MA | BCBS OF MN (01) | MN |
24039 | AMERICA'S PPO (01) | MN |
30229300 | (05) | WI |
A95694 | (02) | MN |
HP13882 | HEALTHPARTNERS (01) | MN |