Provider Demographics
NPI:1699764589
Name:MCDONALD, MAXWELL C III (MD)
Entity type:Individual
Prefix:DR
First Name:MAXWELL
Middle Name:C
Last Name:MCDONALD
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2600 KINGS HWY
Mailing Address - Street 2:SUITE 340
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-3950
Mailing Address - Country:US
Mailing Address - Phone:318-212-8620
Mailing Address - Fax:318-212-8625
Practice Address - Street 1:2600 KINGS HWY
Practice Address - Street 2:SUITE 340
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-3950
Practice Address - Country:US
Practice Address - Phone:318-212-8620
Practice Address - Fax:318-212-8625
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2021-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA025699207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1041521Medicaid
LA4J096Medicare ID - Type UnspecifiedMEDICARE NUMBER
LA1041521Medicaid