Provider Demographics
NPI:1386658409
Name:DONNELLY, WILLIAM PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:PATRICK
Last Name:DONNELLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:WM
Other - Middle Name:PATRICK
Other - Last Name:DONNELLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1004 CARONDELET DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4802
Mailing Address - Country:US
Mailing Address - Phone:816-942-8333
Mailing Address - Fax:816-942-6663
Practice Address - Street 1:1004 CARONDELET DR
Practice Address - Street 2:SUITE 400
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4802
Practice Address - Country:US
Practice Address - Phone:816-942-8333
Practice Address - Fax:816-942-6663
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMOR8282207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
15108024OtherBC/BS PROVIDER NUMBER
180020394OtherRAILROAD MEDICARE NUMBER
2150304OtherAETNA HMO PROVIDER NUMBER
4107883OtherAETNA PPO PROVIDER NUMBER
4107883OtherAETNA PPO PROVIDER NUMBER
4107883OtherAETNA PPO PROVIDER NUMBER
2150304OtherAETNA HMO PROVIDER NUMBER