Provider Demographics
NPI:1922333954
Name:FOOTE, DONOVAN BYRNE (M D)
Entity Type:Individual
Prefix:
First Name:DONOVAN
Middle Name:BYRNE
Last Name:FOOTE
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 PERSHING RD
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-2835
Mailing Address - Country:US
Mailing Address - Phone:402-462-6260
Mailing Address - Fax:
Practice Address - Street 1:1107 N BROADWELL AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-3755
Practice Address - Country:US
Practice Address - Phone:308-398-5312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10741207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEB90699Medicare UPIN