Healthcare Provider Details

I. General information

NPI: 1285682849
Provider Name (Legal Business Name): RICHARD N DONLON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4095 AMERICAN WAY SUITE 1
MEMPHIS TN
38118-8339
US

IV. Provider business mailing address

4095 AMERICAN WAY SUITE 1
MEMPHIS TN
38118-8339
US

V. Phone/Fax

Practice location:
  • Phone: 901-271-9500
  • Fax:
Mailing address:
  • Phone: 901-271-9500
  • Fax: 901-271-9501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License NumberMD0000025066
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25066
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25066
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: