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General NPI Number Information
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NPI Number | 1952424541
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Entity Type | Organization
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Legal Business Name | DONALD E. WONDERLY MD PC
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 08/19/2016
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Provider Practice Location Address
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Address Line | 2460 NW STEWART PKWY SUITE 240
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City | ROSEBURG
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State | OR
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Zip | 97471-1516
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Country | US
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Telephone | 541-677-4427
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Fax | 541-677-6522
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Provider Business Mailing Address
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Address Line | PO BOX 568
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City | WINCHESTER
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State | OR
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Zip | 97495-0568
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Country | US
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Telephone | 541-677-4427
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Fax | 541-677-6522
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Authorized Official
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Title or Position | ASSISTANT OFFICE MANAGER
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Name | KIM A PEACE
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Credential |
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Telephone | 541-677-4427
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD22082
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License Number State | OR
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