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General NPI Number Information
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NPI Number | 1073813630
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Entity Type | Organization
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Legal Business Name | SUSANA T. DONAIRE, MD, PA
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Dates
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Enumeration Date | 10/29/2010
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Last Update Date | 01/23/2012
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Provider Practice Location Address
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Address Line | 255 SE 7TH AVE SUITE 1
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City | CRYSTAL RIVER
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State | FL
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Zip | 34429-4848
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Country | US
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Telephone | 352-564-8620
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Fax | 352-564-9278
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Provider Business Mailing Address
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Address Line | 255 SE 7TH AVE SUITE 1
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City | CRYSTAL RIVER
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State | FL
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Zip | 34429-4848
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Country | US
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Telephone | 352-564-8620
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Fax | 352-564-9278
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | DR. SUSANA T DONAIRE
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Credential | MD
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Telephone | 352-564-8620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME#0045956
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License Number State | FL
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