Donnelly, Mark E
Donnelly, Mark E is an individual health care provider with primary practice located at 1215 N Beaver St Ste 202, Flagstaff AZ 86001-3126. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Donnelly, Mark E can be contacted via phone (928) 773-2200.Contact Information
Primary practice address
1215 N Beaver St Ste 202
Flagstaff AZ 86001-3126
Phone: (928) 773-2200
Fax: (928) 773-2201
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | 18917 | Arizona |
Profile Details
| NPI number | 1902802192 |
|---|---|
| LBN Legal business name | Donnelly, Mark E |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 22nd, 2005 |
| Last updated | Mar 14th, 2017 - about 9 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1902802192 | NPPES |
| Arizona | MEDICAID | 286874 | |
| Arizona | Other | P01112889 |
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