MEDICARE: DR. JAMES W DONNELLY MD

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
1	207N00000X	Dermatology Physician	MDR8G56	MO

General Provider Information

NPI Number	:	1417942400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES W DONNELLY MD

Provider Business Mailing Address
First Line	:	222 S WOODS MILL RD
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-3651
Country	:	US
Telephone Number	:	314-576-1411
Fax Number	:	314-576-2850

Provider Business Practice Location Address
First Line	:	222 S WOODS MILL RD
Second Line	:	SUITE 710N
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-3625
Country	:	US
Telephone Number	:	314-576-1411
Fax Number	:	314-576-2850

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	08/11/2025

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