Healthcare Provider Details

I. General information

NPI: 1912913963
Provider Name (Legal Business Name): MARK ANTHONY DONAHUE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 N BAYOU ST
MOBILE AL
36603-5827
US

IV. Provider business mailing address

PO BOX 2867
MOBILE AL
36652-2867
US

V. Phone/Fax

Practice location:
  • Phone: 251-690-8158
  • Fax: 251-690-8853
Mailing address:
  • Phone: 251-690-8158
  • Fax: 251-690-8853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number13856
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: