Provider Demographics
NPI:1447213723
Name:MCDONALD, JOSHUA MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:MICHAEL
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1948 1ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5321
Mailing Address - Country:US
Mailing Address - Phone:319-364-0121
Mailing Address - Fax:319-364-5684
Practice Address - Street 1:1948 1ST AVE NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5321
Practice Address - Country:US
Practice Address - Phone:319-364-0121
Practice Address - Fax:319-364-5684
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA362082085R0202X, 2085B0100X, 2085R0202X
TXM27062085R0202X
WI528602085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
I52224Medicare UPIN
8G5578Medicare PIN
TX8G1356OtherBCBSTX
IN959090V8Medicare PIN
NM11882026Medicaid
TX179911601Medicaid
TX150420100OtherFIRSTCARE
I52224Medicare UPIN
IN219950F5Medicare PIN
TX179911602Medicaid