Provider Demographics
NPI:1699751313
Name:MCCAULEY, DONALD J (PA-C)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:J
Last Name:MCCAULEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 COFFEE RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-5049
Mailing Address - Country:US
Mailing Address - Phone:661-587-0700
Mailing Address - Fax:661-587-9131
Practice Address - Street 1:3900 COFFEE RD
Practice Address - Street 2:SUITE 3
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-5049
Practice Address - Country:US
Practice Address - Phone:661-587-0700
Practice Address - Fax:661-587-9131
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1424363AS0400X
CA51774363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA4192Medicare UPIN
SC2221Medicare PIN