Organization
KIDNEY CONNECT PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLENN MCDONALD MD (PHYSICIAN)
(903) 234-9992
Entity
Organization
Contact information
Practice address
1402 N 4TH ST, LONGVIEW, TX 75601-4774
(903) 234-9992
Mailing address
1402 N 4TH ST, LONGVIEW, TX 75601-4774
(903) 234-9992
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114429704
—
TX
05
—
135880608
—
TX
05
—
152080101
—
TX
Enumeration date
11/08/2018
Last updated
11/08/2018
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