Provider Demographics
NPI:1952369399
Name:DONOVAN, JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:DONOVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78560 HIGHWAY 111
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-2067
Mailing Address - Country:US
Mailing Address - Phone:760-564-3887
Mailing Address - Fax:760-340-1940
Practice Address - Street 1:78560 HIGHWAY 111
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-2067
Practice Address - Country:US
Practice Address - Phone:760-564-3887
Practice Address - Fax:760-340-1940
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.10523R207W00000X
CAG84806207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1952369399Medicaid
LA4A759Medicare ID - Type Unspecified
G74545Medicare UPIN