Provider Demographics
NPI:1417074717
Name:DONAHUE, DAVID R (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:DONAHUE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 MOUNTAIN VIEW AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3178
Mailing Address - Country:US
Mailing Address - Phone:720-652-8444
Mailing Address - Fax:
Practice Address - Street 1:2030 MOUNTAIN VIEW AVE
Practice Address - Street 2:STE 200
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3178
Practice Address - Country:US
Practice Address - Phone:720-652-8444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102202269208600000X
MN59116208600000X
CO55715208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO71700064Medicaid
CO501038YMMWMedicare PIN