Healthcare Provider Details

I. General information

NPI: 1508098542
Provider Name (Legal Business Name): JESSIE F DONALDSON PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2009
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 GRIDER ST DEPT OF SURGERY ST - MILLER BLDG.
BUFFALO NY
14215-3021
US

IV. Provider business mailing address

PO BOX 8000 DEPT 313 UNIVERSITY AT BUFFALO SURGEONS, INC.
BUFFALO NY
14267-0002
US

V. Phone/Fax

Practice location:
  • Phone: 716-898-5186
  • Fax: 716-898-3194
Mailing address:
  • Phone: 716-888-4889
  • Fax: 716-849-5620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number013512
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: