Individual
MR. DAVID S MACNALLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA C
Contact information
Practice address
1620 E 12TH ST, THE DALLES, OR 97058
(541) 296-9151
(541) 296-4710
Mailing address
PO BOX 1520, THE DALLES, OR 97058
(541) 296-9151
(541) 296-4710
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA10003246
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
218112
—
OR
Enumeration date
06/04/2006
Last updated
06/25/2008
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