Provider Demographics
NPI:1720088743
Name:DONAHUE, JEAN P (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:P
Last Name:DONAHUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:PIERRE
Other - Last Name:DONAHUE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 6230
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-0722
Mailing Address - Country:US
Mailing Address - Phone:304-242-7107
Mailing Address - Fax:304-242-7108
Practice Address - Street 1:1606 HIGHWAY 78 W
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-3668
Practice Address - Country:US
Practice Address - Phone:205-295-9415
Practice Address - Fax:205-295-9418
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-01
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00020327207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000035603Medicaid
AL000035603Medicare ID - Type Unspecified
AL000035603Medicaid