Healthcare Provider Details

I. General information

NPI: 1710968185
Provider Name (Legal Business Name): EDWARD JEFFREY DONNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DR. E JEFFREY DONNER

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4795 LARIMER PKWY
JOHNSTOWN CO
80534-9021
US

IV. Provider business mailing address

4795 LARIMER PKWY
JOHNSTOWN CO
80534-9021
US

V. Phone/Fax

Practice location:
  • Phone: 970-342-2220
  • Fax: 970-342-2221
Mailing address:
  • Phone: 970-342-2220
  • Fax: 970-342-2221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number30264
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: