Healthcare Provider Details

I. General information

NPI: 1366821860
Provider Name (Legal Business Name): CHRISTOPHER DONAHUE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2015
Last Update Date: 10/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1026 A AVE NE STE 5000
CEDAR RAPIDS IA
52402-5036
US

IV. Provider business mailing address

1026 A AVE NE STE 5000
CEDAR RAPIDS IA
52402-5036
US

V. Phone/Fax

Practice location:
  • Phone: 319-369-7085
  • Fax: 319-368-5770
Mailing address:
  • Phone: 319-369-7085
  • Fax: 319-368-5770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number078392
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: