Provider Demographics
NPI:1457315269
Name:DONALDSON, THOMAS KENT (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:KENT
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 1:399 E 21ST ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-4815
Mailing Address - Country:US
Mailing Address - Phone:909-882-5867
Mailing Address - Fax:909-881-7593
Practice Address - Street 1:900 E WASHINGTON ST
Practice Address - Street 2:#200
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-7111
Practice Address - Country:US
Practice Address - Phone:909-882-5867
Practice Address - Fax:909-503-1913
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55682207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00556820Medicaid
CAA53010Medicare UPIN
CA00556820Medicaid
CA5976640001Medicare NSC