Provider Demographics
NPI:1114990777
Name:DONALD, WILLIAM BROOKS (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BROOKS
Last Name:DONALD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2220 RIVERSIDE AVE
Mailing Address - Street 2:MC 31700A
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1321
Mailing Address - Country:US
Mailing Address - Phone:612-371-1600
Mailing Address - Fax:612-371-1673
Practice Address - Street 1:2220 RIVERSIDE AVE
Practice Address - Street 2:MC 31700A
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1321
Practice Address - Country:US
Practice Address - Phone:612-371-1600
Practice Address - Fax:612-371-1673
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2009-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN24665208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN459500900Medicaid
MN370002395Medicare ID - Type Unspecified
MN459500900Medicaid