Provider Demographics
NPI:1073813630
Name:SUSANA T. DONAIRE, MD, PA
Entity Type:Organization
Organization Name:SUSANA T. DONAIRE, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSANA
Authorized Official - Middle Name:T
Authorized Official - Last Name:DONAIRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-564-8620
Mailing Address - Street 1:255 SE 7TH AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-4848
Mailing Address - Country:US
Mailing Address - Phone:352-564-8620
Mailing Address - Fax:352-564-9278
Practice Address - Street 1:255 SE 7TH AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-4848
Practice Address - Country:US
Practice Address - Phone:352-564-8620
Practice Address - Fax:352-564-9278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-29
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME#0045956207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD52023Medicare UPIN