Provider Demographics
NPI:1336106517
Name:DONIE, RAYMOND A (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:A
Last Name:DONIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5422 W THUNDERBIRD RD
Mailing Address - Street 2:SUITE 22
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306
Mailing Address - Country:US
Mailing Address - Phone:602-439-2000
Mailing Address - Fax:602-439-1920
Practice Address - Street 1:5422 W THUNDERBIRD RD
Practice Address - Street 2:SUITE 22
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306
Practice Address - Country:US
Practice Address - Phone:602-439-2000
Practice Address - Fax:602-439-1920
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-30
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ15282207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A15314Medicare UPIN