Individual
BRENTON WAYNE MCDONALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2807 EVANGELINE ST, MONROE, LA 71201-3749
(318) 737-2269
(318) 324-1719
Mailing address
2807 EVANGELINE ST, MONROE, LA 71201-3749
(318) 737-2269
(318) 324-1719
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
12051R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
134436001
MEDICAID
AR
05
—
1542288
—
LA
01
—
300101532
RAILROAD MEDICARE
LA
Enumeration date
06/23/2006
Last updated
12/11/2014
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