MEDICARE: JAMES A. DONNER, PSY.D, P.A.

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	103T00000X	Psychologist	PY7250	FL

General Provider Information

NPI Number	:	1457667438
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES A. DONNER, PSY.D, P.A.

Provider Business Mailing Address
First Line	:	11 RACETRACK RD NE
Second Line	:	SUITE D2
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-1882
Country	:	US
Telephone Number	:	850-586-7762
Fax Number	:	850-586-7763

Provider Business Practice Location Address
First Line	:	11 RACETRACK RD NE
Second Line	:	SUITE D2
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-1882
Country	:	US
Telephone Number	:	850-586-7762
Fax Number	:	850-586-7763

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAMES A DONNER
Credential	:	PSYD
Telephone Number	:	850-586-7762

Provider Enumeration Date	:	08/27/2010
Last Update Date	:	07/08/2013

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