Healthcare Provider Details

I. General information

NPI: 1780641431
Provider Name (Legal Business Name): ELVIS SMITH DONALDSON JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 05/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1780 NICHOLASVILLE RD STE 101
LEXINGTON KY
40503
US

IV. Provider business mailing address

PO BOX 910670
LEXINGTON KY
40591-0670
US

V. Phone/Fax

Practice location:
  • Phone: 859-278-5671
  • Fax: 859-278-5978
Mailing address:
  • Phone: 859-971-4685
  • Fax: 859-971-4602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number16232
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number16232
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: