Provider Demographics
NPI:1780641431
Name:DONALDSON, ELVIS SMITH JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ELVIS
Middle Name:SMITH
Last Name:DONALDSON
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 910670
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40591-0670
Mailing Address - Country:US
Mailing Address - Phone:859-971-4685
Mailing Address - Fax:859-971-4602
Practice Address - Street 1:1780 NICHOLASVILLE RD
Practice Address - Street 2:STE 101
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503
Practice Address - Country:US
Practice Address - Phone:859-278-5671
Practice Address - Fax:859-278-5978
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2013-05-29
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Provider Licenses
StateLicense IDTaxonomies
KY16232207VX0201X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64162324Medicaid
KY64162324Medicaid
C65731Medicare UPIN