Provider Demographics
NPI:1285763862
Name:MCDONALD, ROBERT CHASE (PA-C)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:CHASE
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:ROB
Other - Middle Name:CHASE
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 190930
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83719-0930
Mailing Address - Country:US
Mailing Address - Phone:208-367-5170
Mailing Address - Fax:208-367-5180
Practice Address - Street 1:1150 N SISTER CATHERINE WAY
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-3133
Practice Address - Country:US
Practice Address - Phone:208-302-7050
Practice Address - Fax:208-302-7055
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10005181363A00000X
IDPA-1451363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0221381OtherLABOR & IND.
WA8483737Medicaid
WA8944544OtherCRIME VICTIMS
WA8865712Medicare PIN