Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207KA0200X | Allergist | 46187 | MN |
N | 207P00000X | Emergency Physician | 46187 | MN |
Y | 207Q00000X | Family Doctor | 45889 | WI |
N | 207Q00000X | Family Doctor | 46187 | MN |
NPI | 1497771570 |
---|---|
Provider Name | Terrance E Donnal JR. |
First Address | Madison, WI 53716-2257 |
Second Address | Madison, WI 53716-2257 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 30/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
071641300 | (05) | MN |
105K1D0 | BLUE CROSS BLUE SHIELD (01) | MN |
1497771570 | (05) | WI |
34414700 | MA (01) | WI |
G66395 | (02) | MN |