Provider Demographics
NPI:1750650404
Name:TERRY DONALDSON MD, PC.
Entity Type:Organization
Organization Name:TERRY DONALDSON MD, PC.
Other - Org Name:DONALDSON MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:DONALDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-349-1375
Mailing Address - Street 1:912 WHITEWATER DR
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-7828
Mailing Address - Country:US
Mailing Address - Phone:307-349-1375
Mailing Address - Fax:307-382-0005
Practice Address - Street 1:912 WHITEWATER DR
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-7828
Practice Address - Country:US
Practice Address - Phone:307-349-1375
Practice Address - Fax:307-382-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5702A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty