Healthcare Provider Details

I. General information

NPI: 1720341589
Provider Name (Legal Business Name): JAMES FLINN DONECKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JIM FLINN DONECKER MD

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MT CLEMENT PARK STE C
TAPPAHANNOCK VA
22560-5098
US

IV. Provider business mailing address

PO BOX 780125
PHILADELPHIA PA
19178-0125
US

V. Phone/Fax

Practice location:
  • Phone: 804-443-6030
  • Fax: 804-443-6005
Mailing address:
  • Phone: 804-922-4844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101262779
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: