Provider Demographics
NPI:1487930822
Name:MCDONALD, DAVID GREGORY (ATC)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:GREGORY
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10611
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77710-0611
Mailing Address - Country:US
Mailing Address - Phone:409-880-7394
Mailing Address - Fax:
Practice Address - Street 1:211 REDBIRD LN
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77705-9801
Practice Address - Country:US
Practice Address - Phone:409-880-7394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT40662255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer