Donnelly, Richard E

Donnelly, Richard E is an sole proprietor health care provider with primary practice located at 43 W. White Mountain Blvd , Lakeside AZ 85929-7002. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Surgical, which is considered as his primary health care specialty. Donnelly, Richard E can be contacted via phone (928) 367-4040.

Contact Information

Primary practice address
43 W. White Mountain Blvd Lakeside AZ 85929-7002
Fax: (928) 367-4042

Health care specialties

Profile Details

NPI number 1396729455
LBN Legal business name Donnelly, Richard E
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 2nd, 2005
Last updated Feb 16th, 2011 - about 12 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.

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All States NPI 1396729455 NPPES
Arizona Other 86080015085259A253 TRIWEST
Arizona MEDICAID 558930400 TRIWEST
Arizona Other 970001299 TRIWEST

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