Healthcare Provider Details

I. General information

NPI: 1649232232
Provider Name (Legal Business Name): JEFFREY NEAL DONDINO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 10/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 SOUTH WESTERN AVENUE
TONASKET WA
98855
US

IV. Provider business mailing address

5261 SE BROOKSIDE DR
MILWAUKIE OR
97222-4115
US

V. Phone/Fax

Practice location:
  • Phone: 509-486-2151
  • Fax: 509-486-3102
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD17754
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD00035522
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD17754
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: