1295899482 NPI number — ARTHUR N DONALDSON M D INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295899482 NPI number — ARTHUR N DONALDSON M D INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARTHUR N DONALDSON M D INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1295899482
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
940 SYLVA LN
Provider Second Line Business Mailing Address:
SUITE G
Provider Business Mailing Address City Name:
SONORA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95370-5969
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-736-6555
Provider Business Mailing Address Fax Number:
209-532-1687

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
595 STANISLAUS AVE.
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
ANGELS CAMP
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95222-0387
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-736-5555
Provider Business Practice Location Address Fax Number:
209-532-1687
Provider Enumeration Date:
12/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ARDRON
Authorized Official First Name:
GERARD
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
209-532-0340

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ZZZ27242Z . This is a "BLUE SHIELD GROUP PROVIDR" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: C08447018 . This is a "NSC ENVOY SUBMITTER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GR0085461 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110900 . This is a "EYEMED" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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