Healthcare Provider Details

I. General information

NPI: 1295995090
Provider Name (Legal Business Name): JAMES PATRICK DONOVAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2008
Last Update Date: 09/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2165 LITTLE RD
TRINITY FL
34655-4410
US

IV. Provider business mailing address

2165 LITTLE RD
TRINITY FL
34655-4410
US

V. Phone/Fax

Practice location:
  • Phone: 727-372-6637
  • Fax: 727-375-5044
Mailing address:
  • Phone: 727-372-6637
  • Fax: 727-375-5044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME 120554
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: