Provider Demographics
NPI:1770585630
Name:DONALD, ROBERT L III (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:DONALD
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2819 DENNY AVE
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39581-5301
Mailing Address - Country:US
Mailing Address - Phone:228-762-3466
Mailing Address - Fax:228-762-6349
Practice Address - Street 1:2819 DENNY AVE
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-5301
Practice Address - Country:US
Practice Address - Phone:228-762-3466
Practice Address - Fax:228-762-6349
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS12709207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00114734Medicaid
MS5980040OtherAETNA ID#
MS080003331Medicare ID - Type Unspecified
MSF64933Medicare UPIN