=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578593307
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOSEPH DONNELLY, M.D., A PROFESSIONAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/04/2006
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1133 E STANLEY BLVD SUITE 111
-----------------------------------------------------
City | LIVERMORE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94550-4200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-371-5377
-----------------------------------------------------
Fax | 925-371-0948
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1319
-----------------------------------------------------
City | SALIDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95368-1319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-543-6279
-----------------------------------------------------
Fax | 209-543-6280
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD/PRESIDENT
-----------------------------------------------------
Name | JOSEPH R DONNELLY
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 925-371-5377
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | A78117
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------