MEDICARE: DR. EDWARD JEFFREY DONNER 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	207XS0117X	Orthopaedic Surgery of the Spine Physician	30264	CO

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	:	1710968185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD JEFFREY DONNER MD

Provider Business Mailing Address
First Line	:	4795 LARIMER PKWY
Second Line	:
City	:	JOHNSTOWN
State	:	CO
Zip	:	80534-9021
Country	:	US
Telephone Number	:	970-342-2220
Fax Number	:	970-342-2221

Provider Business Practice Location Address
First Line	:	4795 LARIMER PKWY
Second Line	:
City	:	JOHNSTOWN
State	:	CO
Zip	:	80534-9021
Country	:	US
Telephone Number	:	970-342-2220
Fax Number	:	970-342-2221

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

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	06/29/2023

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