Provider Demographics
NPI:1417903709
Name:DONALDSON, TERRY ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:ROBERT
Last Name:DONALDSON
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 1:1204 HILLTOP DR.
Mailing Address - Street 2:SUITE 108
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901
Mailing Address - Country:US
Mailing Address - Phone:307-352-8125
Mailing Address - Fax:307-352-8126
Practice Address - Street 1:1204 HILLTOP DR.
Practice Address - Street 2:SUITE 108
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901
Practice Address - Country:US
Practice Address - Phone:307-352-8125
Practice Address - Fax:307-352-8126
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5702A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY110853100Medicaid
WY110853100Medicaid
306931Medicare ID - Type Unspecified