Provider Demographics
NPI:1760533533
Name:DONOVAN, BEN O'NEILL (MD)
Entity Type:Individual
Prefix:DR
First Name:BEN
Middle Name:O'NEILL
Last Name:DONOVAN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:13555 W MCDOWELL RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2624
Mailing Address - Country:US
Mailing Address - Phone:623-935-5522
Mailing Address - Fax:623-935-3220
Practice Address - Street 1:13555 W MCDOWELL RD
Practice Address - Street 2:SUITE 304
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2624
Practice Address - Country:US
Practice Address - Phone:623-935-5522
Practice Address - Fax:623-935-3220
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2011-12-07
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Provider Licenses
StateLicense IDTaxonomies
OK22961208800000X
AZ377642088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ343929Medicaid
AZZ122694Medicare PIN