Provider Demographics
NPI:1639114218
Name:DONOHUE, CARY TRENT (DPM)
Entity Type:Individual
Prefix:DR
First Name:CARY
Middle Name:TRENT
Last Name:DONOHUE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 DUBLIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-1023
Mailing Address - Country:US
Mailing Address - Phone:504-439-8530
Mailing Address - Fax:
Practice Address - Street 1:831 DUBLIN ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-1023
Practice Address - Country:US
Practice Address - Phone:504-439-8530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD195R213E00000X
SC523213E00000X
MS80180213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPD5232Medicaid
LA1549525Medicaid
MS05001054OtherMEDICAID PROVIDER NUMBER
MS480000151Medicare PIN
LA1549525Medicaid
LA5H388Medicare PIN
MS05001054OtherMEDICAID PROVIDER NUMBER
LA5E232Medicare ID - Type Unspecified