Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | G55682 | CA |
NPI | 1457315269 |
---|---|
Provider Name | Thomas Kent Donaldson |
First Address | San Bernardino, CA 92404-4815 |
Second Address | Colton, CA 92324-7111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 15/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00556820 | (05) | CA |
A53010 | (02) | CA |