Provider Demographics
NPI:1659373314
Name:DONNELL, DAVID N (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:N
Last Name:DONNELL
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 1:4848 LEMMON AVE
Mailing Address - Street 2:STE 100 LB 508
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-1400
Mailing Address - Country:US
Mailing Address - Phone:866-811-3555
Mailing Address - Fax:866-370-0570
Practice Address - Street 1:4848 LEMMON AVE
Practice Address - Street 2:STE 100 LB 508
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-1400
Practice Address - Country:US
Practice Address - Phone:866-811-3555
Practice Address - Fax:866-370-0570
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8006207P00000X, 207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH8006OtherTEXAS LICENSURE
TXH8006OtherTEXAS LICENSURE