Provider Demographics
NPI:1184937617
Name:STEPHEN L DONALDSON, M.D. P.C.
Entity type:Organization
Organization Name:STEPHEN L DONALDSON, M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DONALDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-375-6565
Mailing Address - Street 1:1275 N UNIVERSITY AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-2679
Mailing Address - Country:US
Mailing Address - Phone:801-375-6565
Mailing Address - Fax:801-373-9750
Practice Address - Street 1:1275 N UNIVERSITY AVE STE 10
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-2679
Practice Address - Country:US
Practice Address - Phone:801-375-6565
Practice Address - Fax:801-373-9750
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEPHEN L DONALDSON, M.D. P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1800901205207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTE91807Medicare UPIN
000010091Medicare PIN