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NPI Code Detail

MEDICARE: DR. RYAN THOMAS DONNELLY M.D.

MEDICARE: DR. RYAN THOMAS DONNELLY M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics PhysicianDR.0077202CO
2208000000XPediatrics Physician7148380-1205UT

General Provider Information

NPI Number : 1205089661
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RYAN THOMAS DONNELLY M.D.
Provider Business Mailing Address
First Line : 2749 S HARTFORD ST
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84106-3652
Country : US
Telephone Number : 801-485-2720
Fax Number :
Provider Business Practice Location Address
First Line : 7138 S 2000 E
Second Line : #106
City : SALT LAKE CITY
State : UT
Zip : 84121-3757
Country : US
Telephone Number : 801-942-1800
Fax Number : 801-944-1865
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/29/2008
Last Update Date : 05/15/2026

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