Provider Demographics
NPI:1073696183
Name:CORBYONS & DONOHOE SURGICAL ASSOCIATES MD PA
Entity Type:Organization
Organization Name:CORBYONS & DONOHOE SURGICAL ASSOCIATES MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DONOHOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-738-5300
Mailing Address - Street 1:685 PEACHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-0804
Mailing Address - Country:US
Mailing Address - Phone:386-738-5300
Mailing Address - Fax:386-738-9537
Practice Address - Street 1:685 PEACHWOOD DR
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-0804
Practice Address - Country:US
Practice Address - Phone:386-738-5300
Practice Address - Fax:386-738-9537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL33571OtherGROUP BC/BS
FL379920400Medicaid
FL33571OtherGROUP BC/BS