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Individual

W MICHAEL MCDONNELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
500 W. FORT ST., # 111, BOISE, ID 83702
(208) 422-1000
(208) 422-1319
Mailing address
500 W. FORT ST., # 111, BOISE, ID 83702
(208) 422-1000
(208) 422-1319

Taxonomy

Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
MD00035287
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0115863
LABOR AND INDUSTRY
WA
01
100010270
RAILROAD MEDICARE
05
8209629
WA
01
MD00035287
STATE LICENSE NUMBER
WA
Enumeration date
06/09/2006
Last updated
06/23/2022
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