Individual
DR. DOUGLAS KYLE MCDONALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2401 S 31ST ST, DEPT OF RADIOLOGY, TEMPLE, TX 76508-0001
(254) 724-2111
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
223375
MA
2085R0204X
Vascular & Interventional Radiology Physician
Primary
L6109
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2101327
—
MA
01
—
462203
TUFTS HEALTH PLAN
MA
01
—
J28639
BCBS MA
MA
Enumeration date
11/08/2005
Last updated
01/27/2022
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