Provider Demographics
NPI:1063440386
Name:MCDONALD, ANN ROBY (PA)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:ROBY
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5416 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-5603
Mailing Address - Country:US
Mailing Address - Phone:205-391-8657
Mailing Address - Fax:
Practice Address - Street 1:701 UNIVERSITY BLVD E
Practice Address - Street 2:SUITE 808
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401
Practice Address - Country:US
Practice Address - Phone:205-759-5640
Practice Address - Fax:205-759-5639
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA-40363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00366358OtherRAILROAD MEDICARE PIN
AL051557740Medicaid