Healthcare Provider Details

I. General information

NPI: 1710919105
Provider Name (Legal Business Name): JAMES ALLEN DONNER PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 06/15/2020
Certification Date: 06/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 N 12TH AVE BLDG B
ARCADIA FL
34266-8752
US

IV. Provider business mailing address

11 RACETRACK RD NE SUITE D2
FORT WALTON BEACH FL
32547-1882
US

V. Phone/Fax

Practice location:
  • Phone: 863-494-1242
  • Fax: 863-491-0466
Mailing address:
  • Phone: 850-586-7762
  • Fax: 850-586-7763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY7250
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: