Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | A86040 | CA |
Y | 208600000X | Surgeon | A86040 | CA |
N | 2086X0206X | Surgical Oncologist | A86040 | CA |
NPI | 1033361282 |
---|---|
Provider Name | Timothy Ryan Donahue |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Los Angeles, CA 90095-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2008 |
Last Update Date | 23/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A860400 | (05) | CA |