Mark E Donnelly, M.D.
Specialist in Flagstaff, AZ. Individual provider (NPI-1).
NPI number1902802192
StatusActive
Last updated in NPPESMar 14, 2017
Details
- NPI
- 1902802192
- Entity type
- Individual (NPI-1)
- Name
- Mark E Donnelly
- Credential
- M.D.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jun 22, 2005
- Last updated
- Mar 14, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 174400000X | Specialist | 18917 | AZ | Yes |
Practice location
1215 N Beaver StSte 202
Flagstaff, AZ 86001-3126
Phone 928-773-2200 · Fax 928-773-2201
Mailing address
1200 N Beaver StPayer Credentialing
Flagstaff, AZ 86001-3118
Phone 928-773-2559 · Fax 928-213-6292
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