Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | #675 | NM |
Y | 103TC0700X | Clinical Psychologist | #675 | NM |
N | 103TH0100X | Health Service | 675 | NM |
NPI | 1366493769 |
---|---|
Provider Name | Dr. Paul Bernard Donovan |
First Address | Santa Fe, NM 87505 |
Second Address | Santa Fe, NM 87505-4776 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 29/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R18732 | (02) | NM |
S3976. | (05) | NM |