Provider Demographics
NPI:1447251798
Name:MCDONALD, HARRISON MARK (DO)
Entity type:Individual
Prefix:DR
First Name:HARRISON
Middle Name:MARK
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1923 MCCULLOCH BLVD N
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403
Mailing Address - Country:US
Mailing Address - Phone:928-208-4611
Mailing Address - Fax:928-453-4645
Practice Address - Street 1:1923 MCCULLOCH BLVD N
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403
Practice Address - Country:US
Practice Address - Phone:928-208-4611
Practice Address - Fax:928-453-4645
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2022-03-09
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-11
Provider Licenses
StateLicense IDTaxonomies
AZ2793207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine