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General NPI Number Information
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NPI Number | 1497880991
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Entity Type | Individual
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Provider Name | DAVID DONELSON
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Gender | Male
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 09/23/2013
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Provider Practice Location Address
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Address Line | 559 VINCENT ST BLDG 959 FLIGHT MEDICINE CLINIC
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City | COLORADO SPRINGS
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State | CO
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Zip | 80914-1541
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Country | US
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Telephone | 719-556-1260
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Fax |
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Provider Business Mailing Address
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Address Line | 559 VINCENT ST BLDG 959 FLIGHT MEDICINE CLINIC
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City | COLORADO SPRINGS
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State | CO
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Zip | 80914-1541
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Country | US
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Telephone | 719-556-1260
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1686
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License Number State | CO
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