Provider Demographics
NPI:1508098542
Name:DONALDSON, JESSIE F (PA)
Entity Type:Individual
Prefix:MR
First Name:JESSIE
Middle Name:F
Last Name:DONALDSON
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Gender:M
Credentials:PA
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Mailing Address - Street 1:PO BOX 8000 DEPT 313
Mailing Address - Street 2:UNIVERSITY AT BUFFALO SURGEONS, INC.
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14267-0002
Mailing Address - Country:US
Mailing Address - Phone:716-888-4889
Mailing Address - Fax:716-849-5620
Practice Address - Street 1:462 GRIDER ST
Practice Address - Street 2:DEPT OF SURGERY ST - MILLER BLDG.
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3021
Practice Address - Country:US
Practice Address - Phone:716-898-5186
Practice Address - Fax:716-898-3194
Is Sole Proprietor?:No
Enumeration Date:2009-08-10
Last Update Date:2014-04-02
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Provider Licenses
StateLicense IDTaxonomies
NY013512363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03156296Medicaid
J400007921Medicare PIN