Basic Information
| Provider Information | |||||||||
| NPI: | 1518121664 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCDONALD | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | RIVINGTON | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1098 CHARTER ROW | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376044357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4233354750 | ||||||||
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| Practice Location | |||||||||
| Address1: | #1 DOGWOOD LANE | ||||||||
| Address2: | DEPT. OF SURGERY | ||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234396267 | ||||||||
| FaxNumber: | 4234396259 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2008 | ||||||||
| LastUpdateDate: | 11/12/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 0000051685 | TN | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.