MEDICARE: MR. JEFFREY DONNER

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	247200000X	Other Technician

General Provider Information

NPI Number	:	1467592428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY DONNER

Provider Business Mailing Address
First Line	:	2435 EAGLE RUN WAY
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33327-1432
Country	:	US
Telephone Number	:	954-605-2737
Fax Number	:	954-349-8672

Provider Business Practice Location Address
First Line	:	2435 EAGLE RUN WAY
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33327-1432
Country	:	US
Telephone Number	:	954-605-2737
Fax Number	:	954-349-8672

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	07/09/2007

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Directions to “ MR. JEFFREY DONNER ” Practice Location

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