Provider Demographics
NPI:1578236261
Name:DONALDSON, DAVID BRIAN (NBC-HWC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:BRIAN
Last Name:DONALDSON
Suffix:
Gender:M
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2411 W MELODY DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-7636
Mailing Address - Country:US
Mailing Address - Phone:602-703-3222
Mailing Address - Fax:
Practice Address - Street 1:2411 W MELODY DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-7636
Practice Address - Country:US
Practice Address - Phone:602-703-3222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZA-3404449