Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MD60729370 | WA |
Y | 208600000X | Surgeon | MD60729370 | WA |
N | 2086X0206X | Surgical Oncologist | MD181298 | OR |
NPI | 1205062692 |
---|---|
Provider Name | Cory Amanda Donovan |
First Address | Los Angeles, CA 90010-4041 |
Second Address | Portland, OR 97210-3097 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2009 |
Last Update Date | 05/08/2021 |