Provider Demographics
NPI:1487744090
Name:MACDONALD, JOEL DOUGLAS (MD)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:DOUGLAS
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2660 E 3300 S APT 19
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-2761
Mailing Address - Country:US
Mailing Address - Phone:801-244-6959
Mailing Address - Fax:
Practice Address - Street 1:82 S 1100 E STE 103
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1889
Practice Address - Country:US
Practice Address - Phone:801-505-5370
Practice Address - Fax:801-984-6657
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT183354-1205207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery