Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | G3302 | TX |
N | 207VX0000X | Obstetrician | G3302 | TX |
NPI | 1225034515 |
---|---|
Provider Name | Bobby Eugene Donohue JR. |
First Address | Stephenville, TX 76401-2207 |
Second Address | Stephenville, TX 76401-2207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 01/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1114902-01 | (05) | TX |
C15327 | (02) | TX |