1710945860 NPI number — ROBERT ALFRED DONATO M.D.

Table of content: ALVARO LICTO RD (NPI 1770760530)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710945860 NPI number — ROBERT ALFRED DONATO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DONATO
Provider First Name:
ROBERT
Provider Middle Name:
ALFRED
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710945860
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
995 S YATES RD
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38119-0882
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-527-7100
Provider Business Mailing Address Fax Number:
901-527-7124

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
995 S YATES RD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38119-0882
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-527-7100
Provider Business Practice Location Address Fax Number:
901-527-7124
Provider Enumeration Date:
05/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  36335 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208800000X , with the licence number: 17711 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3722370 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2079595 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3873632 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02110026200 . This is a "QUAL CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 660724 . This is a "HEALTH LINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4041786 . This is a "BLUE CROSS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 99287 . This is a "BLUE CROSS AR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 13305935 . This is a "PHCS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 211159 . This is a "SOUTHERN HEALTH SERVICES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7436345 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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