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NPI Code Detail

MEDICARE: RICHARD THOMAS DONOVAN P.A.-C

MEDICARE: RICHARD THOMAS DONOVAN P.A.-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician AssistantPA 2034FL

General Provider Information

NPI Number : 1013018837
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD THOMAS DONOVAN P.A.-C
Provider Business Mailing Address
First Line : 2907 KERRY FOREST PKWY
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32309-6825
Country : US
Telephone Number : 850-668-3380
Fax Number : 850-668-3226
Provider Business Practice Location Address
First Line : 2907 KERRY FOREST PKWY
Second Line :
City : TALLAHASSEE
State : FL
Zip : 32309-6825
Country : US
Telephone Number : 850-668-3380
Fax Number : 850-668-3226
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2006
Last Update Date : 05/05/2015

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