Healthcare Provider Details

I. General information

NPI: 1639114218
Provider Name (Legal Business Name): CARY TRENT DONOHUE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 09/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 DUBLIN ST
NEW ORLEANS LA
70118-1023
US

IV. Provider business mailing address

831 DUBLIN ST
NEW ORLEANS LA
70118-1023
US

V. Phone/Fax

Practice location:
  • Phone: 504-439-8530
  • Fax:
Mailing address:
  • Phone: 504-439-8530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPD195R
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number523
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number80180
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: