Provider Demographics
NPI:1710968185
Name:DONNER, EDWARD JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JEFFREY
Last Name:DONNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:E JEFFREY
Other - Middle Name:
Other - Last Name:DONNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4795 LARIMER PKWY
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80534-9021
Mailing Address - Country:US
Mailing Address - Phone:970-342-2220
Mailing Address - Fax:970-342-2221
Practice Address - Street 1:4795 LARIMER PKWY
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:CO
Practice Address - Zip Code:80534-9021
Practice Address - Country:US
Practice Address - Phone:970-342-2220
Practice Address - Fax:970-342-2221
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30264207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01302645Medicaid
WY100872200Medicaid
COB7728Medicare PIN
CO01302645Medicaid
COCB7728Medicare PIN
B41729Medicare UPIN