Provider Demographics
NPI:1306289368
Name:MCDONALD, AARON DAVID (EDS, MED, LAT)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:DAVID
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:EDS, MED, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 W MCNEESE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-4242
Mailing Address - Country:US
Mailing Address - Phone:337-217-4410
Mailing Address - Fax:337-217-4412
Practice Address - Street 1:1500 W MCNEESE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-4242
Practice Address - Country:US
Practice Address - Phone:337-217-4410
Practice Address - Fax:337-217-4412
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAJ002622255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer