Provider Demographics
NPI:1720099534
Name:MUMERT, DONNA J (MD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:J
Last Name:MUMERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 CENTRACARE CIRCLE
Mailing Address - Street 2:#1450, CENTRACARE CLINIC - PLAZA - FAMILY MEDICINE
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-5000
Mailing Address - Country:US
Mailing Address - Phone:320-229-4917
Mailing Address - Fax:
Practice Address - Street 1:1900 CENTRACARE CIRCLE
Practice Address - Street 2:#1450, CENTRACARE CLINIC - PLAZA - FAMILY MEDICINE
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-229-4917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND7421207Q00000X
IA37828207Q00000X
MN49196207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN550G7MUOtherBLUE CROSS BLUE SHEILD
MN01-24227OtherMEDICA
MNHP69862OtherHEALTH PARTNERS
MNHP69862OtherHEALTH PARTNERS
BM4824377OtherDEA
MN80015172Medicare ID - Type UnspecifiedMEICARE