Provider Demographics
NPI:1679815294
Name:TIMOTHY J DONOVAN MD LLC
Entity Type:Organization
Organization Name:TIMOTHY J DONOVAN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JOSPEH
Authorized Official - Last Name:DONOVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-239-2600
Mailing Address - Street 1:103 WEST UNIVERSITY PARKWAY
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-4482
Mailing Address - Country:US
Mailing Address - Phone:337-239-2600
Mailing Address - Fax:337-239-2601
Practice Address - Street 1:103 WEST UNIVERSITY PARKWAY
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-4482
Practice Address - Country:US
Practice Address - Phone:337-239-2600
Practice Address - Fax:337-239-2601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-21
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD203745207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty