Provider Demographics
NPI:1992743066
Name:MCDONALD, ROBERT HILTON (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:HILTON
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 1:100 MERCY WAY
Mailing Address - Street 2:STE 560
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-4524
Mailing Address - Country:US
Mailing Address - Phone:417-556-8566
Mailing Address - Fax:417-556-8569
Practice Address - Street 1:100 MERCY WAY
Practice Address - Street 2:STE 560
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-4524
Practice Address - Country:US
Practice Address - Phone:417-556-8566
Practice Address - Fax:417-556-8569
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3677207Y00000X
MO2006035755207YX0905X, 207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1992743066Medicaid
KS200547350BMedicaid
OK100165850AMedicaid
MOMA2082103Medicare PIN