Provider Demographics
NPI:1699986604
Name:CRAIG L. MCDONALD MDPA
Entity type:Organization
Organization Name:CRAIG L. MCDONALD MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-849-9557
Mailing Address - Street 1:2327 E MULBERRY
Mailing Address - Street 2:SUITE C
Mailing Address - City:ANGLETON
Mailing Address - State:TX
Mailing Address - Zip Code:77515-3836
Mailing Address - Country:US
Mailing Address - Phone:979-849-9557
Mailing Address - Fax:979-849-0879
Practice Address - Street 1:2327 E MULBERRY
Practice Address - Street 2:SUITE C
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515-3836
Practice Address - Country:US
Practice Address - Phone:979-849-9557
Practice Address - Fax:979-849-0789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4839207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165338802Medicaid
TXH4839OtherSTATE PROVIDER NUMBER
TX5700160001Medicare NSC
TXH4839OtherSTATE PROVIDER NUMBER
TX165338802Medicaid