Provider Demographics
NPI:1578671632
Name:DONAHUE, DAVID J (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:DONAHUE
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:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:1500 COOPER ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2710
Practice Address - Country:US
Practice Address - Phone:682-885-2500
Practice Address - Fax:682-885-2510
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0719207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10006574OtherAMERIGROUP PIN
TX1117877101OtherFIRSTCARE PIN
TX137345810Medicaid
TX089893404Medicaid
TX1148941OtherUHC PIN
TX4205310OtherAETNA PIN
TX5129854OtherCCN PIN
TX140442852Medicaid
1750369203OtherGRP NPI NUMBER
TX147730OtherPHCS PIN
TX124162OtherSUPERIOR PIN
TX827009OtherFIRSTHEALTH PIN
TX8F0037OtherBCBSTX IND PIN
TX00U87ZOtherBCBSTX GRP PIN
TX089893403Medicaid
TX2614591OtherCIGNA PIN
TX140442852Medicaid
TX8F0037OtherBCBSTX IND PIN
TX147730OtherPHCS PIN