Provider Demographics
NPI:1386728368
Name:MCDONALD, FRANK (DO)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:DO
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 901
Mailing Address - Street 2:
Mailing Address - City:ROCIADA
Mailing Address - State:NM
Mailing Address - Zip Code:87742-0901
Mailing Address - Country:US
Mailing Address - Phone:505-617-0380
Mailing Address - Fax:
Practice Address - Street 1:1501 SAN PEDRO DR. SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108
Practice Address - Country:US
Practice Address - Phone:505-425-1910
Practice Address - Fax:505-425-1905
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43260207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO49788272Medicaid
102560Medicare ID - Type Unspecified
H73965Medicare UPIN