Provider Demographics
NPI:1275518128
Name:MEDUNA, DONALD MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:MARK
Last Name:MEDUNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:545 3RD ST
Mailing Address - Street 2:# 1035
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-1035
Mailing Address - Country:US
Mailing Address - Phone:719-488-6980
Mailing Address - Fax:
Practice Address - Street 1:10TH MEDICAL GROUP
Practice Address - Street 2:4102 PINION DRIVE, SUITE 100
Practice Address - City:USAF ACADEMY
Practice Address - State:CO
Practice Address - Zip Code:80840-4000
Practice Address - Country:US
Practice Address - Phone:719-333-5171
Practice Address - Fax:719-333-5091
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO431382085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP00695823Medicare PIN
COCO40999Medicare PIN
COCO303178Medicare PIN
COCO300876Medicare PIN
CO173216Medicare UPIN