MEDICARE: DONOVAN JOHN ANDERSON MD

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
1	207Q00000X	Family Medicine Physician	13491	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356333058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONOVAN JOHN ANDERSON MD

Provider Business Mailing Address
First Line	:	8700 HIGHWAY 95
Second Line	:
City	:	MOHAVE VALLEY
State	:	AZ
Zip	:	86440-8519
Country	:	US
Telephone Number	:	928-768-7113
Fax Number	:	928-788-2481

Provider Business Practice Location Address
First Line	:	8700 HIGHWAY 95
Second Line	:
City	:	MOHAVE VALLEY
State	:	AZ
Zip	:	86440-8519
Country	:	US
Telephone Number	:	928-768-7113
Fax Number	:	928-788-2481

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	07/08/2007

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Directions to “ DONOVAN JOHN ANDERSON MD” Practice Location

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