Individual provider · Type 1 NPI
Richard E. Donnelly, P.A.-C.
Surgical Physician Assistant · Lakeside, AZ
NPI number
1396729455
Active
Practice location
43 W. White Mountain Blvd
Lakeside, AZ 85929-7002
Fax (928) 367-4042
Mailing address
43 W White Mountain Blvd
Lakeside, AZ 85929-7002
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Surgical Physician Assistant Primary | 363AS0400X | 1105 (AZ) |
| Surgical Physician Assistant | 363AS0400X | 10186 (MN) |
Surgical Physician Assistant: Definition to come...
About NPI 1396729455
Richard E. Donnelly, P.A.-C.'s National Provider Identifier is 1396729455, issued on Dec 2, 2005. The primary taxonomy on file is Surgical Physician Assistant (363AS0400X), and the practice location is in Lakeside, AZ. The record was last updated on Feb 16, 2011.