Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | A78117 | CA |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | A78117 | CA |
NPI | 1114979176 |
---|---|
Provider Name | Joseph R Donnelly |
First Address | Pleasanton, CA 94588-4007 |
Second Address | Pleasanton, CA 94588-4007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 25/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I34509 | (02) | CA |