Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 036103262 | IL |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 036103262 | IL |
NPI | 1891760385 |
---|---|
Provider Name | Dr. Terry L Donat |
First Address | Sterling, IL 61081-1252 |
Second Address | Sterling, IL 61081-1252 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2006 |
Last Update Date | 14/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036103262 | (05) | IL |
G21803 | (02) | IL |