Healthcare Provider Details

I. General information

NPI: 1063489573
Provider Name (Legal Business Name): TODD DONATO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 08/21/2020
Certification Date: 08/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11315 BRIDGEPORT WAY SW
LAKEWOOD WA
98499-3004
US

IV. Provider business mailing address

3633 PACIFIC AVE SUITE 204
TACOMA WA
98418-7900
US

V. Phone/Fax

Practice location:
  • Phone: 253-985-6403
  • Fax: 253-985-2948
Mailing address:
  • Phone: 253-274-1668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number37054
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: