Provider Demographics
NPI:1336181510
Name:LUIS E. DONAYRE, M.D., P.A.
Entity Type:Organization
Organization Name:LUIS E. DONAYRE, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:ERNESTO
Authorized Official - Last Name:DONAYRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-642-3136
Mailing Address - Street 1:711 N FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-3412
Mailing Address - Country:US
Mailing Address - Phone:910-642-3136
Mailing Address - Fax:910-642-3137
Practice Address - Street 1:711 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-3412
Practice Address - Country:US
Practice Address - Phone:910-642-3136
Practice Address - Fax:910-642-3137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15749208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
011KUOtherBCBS GROUP PROVIDER NUMBE
28830OtherBCBS INDIVIDUAL PROVIDER
NC8928830Medicaid
28830OtherBCBS INDIVIDUAL PROVIDER
NC2318864Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NC8928830Medicaid