Healthcare Provider Details

I. General information

NPI: 1457343014
Provider Name (Legal Business Name): DONOVAN C JAMES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 E ORMAN AVE SUITE A109
PUEBLO CO
81004-3537
US

IV. Provider business mailing address

1925 E ORMAN AVE SUITE A109
PUEBLO CO
81004-3537
US

V. Phone/Fax

Practice location:
  • Phone: 719-564-0210
  • Fax: 719-564-9483
Mailing address:
  • Phone: 719-564-0210
  • Fax: 719-564-9483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number43156
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: